National Council Magazine - Suicide Prevention Edition
Editorial advisor for “Suicide Prevention is Everybody’s Business: Not Another Life to Lose” special edition including Surgeon General’s revised National Strategy.
Published on: Mar 3, 2016
Transcripts - National Council Magazine - Suicide Prevention Edition
Published by the National Council for Community Behavioral Healthcare
2 0 1 2 , I s s u e 2
m a g a z i n e
NationalCouncilSharing Best Practices in Mental Health & Addictions TREATMENT www.TheNationalCouncil.org
The Smoking Gun in Suicides Linda Rosenberg
The Bridge to Zero David Covington, Michael Hogan
Connection is Prevention Surgeon General Regina Benjamin
They’ll Be Glad They Lived Army Secretary John McHugh
Why People Die by Suicide Thomas Joiner
Shattering the Black Suicide Myth Donna Barnes
What Airlines Can Teach Us About
Suicide Prevention Paul Schyve
Boy, Interrupted Dana Perry
Not another life to lose
This special issue is sponsored by
Magellan Health Services
NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2 / 1
Not Another Life to Lose:
This special issue is sponsored by
Magellan Health Services
National Council Magazine, 2012, Issue 2President & CEO
Special Editor, Suicide Prevention Issue
David Covington, Vice President, Adult & Youth Services, Magellan
Health Services and Board Director, National Council for Community
Meena Dayak, Vice President, Marketing & Communications
Health Communications Specialist
Director of Mental Health First Aid Operations
Digital and Social Media Marketing Manager
Nathan Sprenger, Marketing and Communications Associate
National Council Magazine thanks the following individuals for support and
guidance on the suicide prevention issue
David Litts, Executive Secretary, National Action Alliance for Suicide Prevention
Jason Padgett, Task Force Liaison, Secretariat, National Action Alliance for
Jerry Reed, Co-lead, National Strategy for Suicide Prevention Task Force,
National Action Alliance on Suicide Prevention
PDF available at www.TheNationalCouncil.org
(look under About Us/National Council Magazine)
Editorial and Advertising Inquiries
National Council Magazine Editorial Advisory Board
Neal Cash, CEO, Community Partnership of Southern Arizona, Tucson, AZ
Pat Connell, Director, Boystown National Research Hospital, Omaha, NE
David Covington, Vice President, Adult & Youth Services, Magellan
Health Services, Phoenix, AZ
About the National Council
The National Council for Community Behavioral Health-
care (National Council) is the unifying voice of America’s
behavioral health organizations. Together with our 2,000
member organizations, we serve our nation’s most
vulnerable citizens — more than 8 million adults and
children with mental illnesses and addiction disorders.
We are committed to providing comprehensive,
high-quality care that affords every opportunity for
recovery and inclusion in all aspects of community life.
The National Council advocates for policies that ensure
that people who are ill can access comprehensive
healthcare services. We also offer state-of-the-science
education and practice improvement resources so that
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2 / NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2
Leading the way
6 The Smoking Gun in Suicides
8 Editorial: Not Another Life to Lose: The Bridge to Zero
David Covington, Michael Hogan
12 Infographic: Suicide in America
14 They’ll Be Glad They Lived
Army Secretary John McHugh
16 America’s Doctor Says Connection is Prevention
Surgeon General Regina Benjamin
18 National Milestones in Suicide Prevention
20 2012 National Strategy for Suicide Prevention
Jerry Reed, National Action Alliance for Suicide Prevention
26 SAMHSA Takes a Public Health Approach to Suicide Prevention
30 Where is the Risk? What the Science Tells Us About Suicide
34 Type Casting to Save Lives
36 Why People Die by Suicide
38 Weapons in the War on Suicide
40 Saving Lives, the Forward March
42 Greater than the Pull Toward Death
44 Global Classroom: Suicide Prevention Lessons from
Around the World
: The New Language of Crisis
Advertorial, Behavioral Health Link
48 After a Suicide: Postvention Is Prevention
Joanne Harpel, Ken Norton
50 Shattering the Black Suicide Myth
52 A Legacy of Strength: Changing the Tide Among
American Indians and Alaska Natives
Cortney Yarholar, Petrice Post, Elly Stout
NationalCouncilM A G A Z I N E
Into the Light: Stories of Courage and Hope
7 I’ll Gladly Pay the Price
15 We Gave More Hugs
25 Life Is a Gift
33 Reach One, Teach One
45 Too Few Years, Too Few Memories
54 Different Kinds of Battles
Mark Graham, Carol Graham
66 Boy, Interrupted: Sharing the Pain through the Lens
73 A Life Worth Living
117 Failure Equals Success
121 Running to Pole 69
129 Accepting What Is and What Is Not
153 More than One Life
Gun in Suicides
NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2 / 3
56 The Battle Back Home: Overcoming the Reluctance to Ask for Help
60 We Owe it to Them: Supporting Our Veterans
Neal Cash, Vanessa Seaney, Lauryn Bianco
62 Older Adults: Changing the Alarming Statistics
70 The Psychological Autopsy: What Makes Youth Vulnerable to
72 A Son’s Bequest: What Can Colleges and Universities Do to
Phil Satow, John MacPhee, Victor Schwartz
74 Best Time of Their Lives? Sending the Silence Packing on Campus
76 Coming Out of the Closet: Unearthing the Facts on LGBT Suicide
Andrew Lane, Mikel Walters
78 Reversing the Culture of Suicide in Rural America: Advantage
Tamara DeHay, Mimi McFaul, Jeremy Vogt
80 Revealing the Colors: Managing Suicide Risk in the Substance
Ann Mitchell, Holly Hagle, Kimberly Talcott
81 Culture Shock: Latina Teens Face Suicide Risk
83 NATIONAL COUNCIL HALL OF HONOR
REINTEGRATION, WELCOME BACK, IMPACT AWARDS
Programs and Tools
92 A Living Legacy: Lessons from America’s First Suicide Prevention
94 Root Cause Analysis: What Airlines Can Teach Us About Suicide
96 Class Is in Session: Research Recommends Targeting Suicidal
Katherine Comtois, Erin Ward-Cieslieski, Marsha Linehan
98 Care Pays: ROI from Better Transitions
Tami Mark, John Richardson
100 I Just Called to Say How Much I Care
102 The Trauma-Suicide Link: An ACE on Coping Strategies
94Root Cause Analysis: What
Airlines Can Teach Us About
60We Owe it to Them:
72What Can Colleges
and Universities Do
to Prevent Suicide?
4 / NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2
NationalCouncilM A G A Z I N E
104 Where Zero Is the Perfect Number
106 Something Can Be Done
108 Driving Suicides to Zero: New Vistas from the Grand
Donald Erickson, Karen Chaney, Gregory Gale, Kent Eller
114 Just One Death is a Failure: The Empire State Takes
a Systems Approach
Melanie Puorto Conte
116 Bluegrass State Says “Never” to Suicide
118 Lone Star State Engages the Public in Suicide Prevention
119 Building a Culture of Acceptance, Engagement, and
Safety to Prevent Suicide
Advertorial, Optum Health
120 Health Workers as Gatekeepers: Why Training Trumps
122 Training or Tragedy: The Choice is Clear
124 Weaving a Net of Clinicians Trained in Suicide Care
Laurie Davidson, Anthony Pisani
126 Changing Workplace Culture to End the Suicide Standstill
Richard Paul, Sally Spencer-Thomas
128 Don’t Be Afraid to Ask: The Mental Health First Aid
Bryan Gibb, Susan Partain
130 Vital Signs, Suicide Attempts CAN Be Predicted
132 Man to Man: Tackling Suicide Head On
134 Life Savers: That’s a WRAP
Mary Ellen Copeland, Carol Bailey Floyd
136 Everyone is Responsible: It Takes a Competent Community
to Stop Youth Suicide
138 NFL Kicks Off New Game to Save Lives
139 Journey of Hope – Katie’s Story
140 Filling the Adolescent Suicide Ravine with Screening and
Guy Diamond, Joel Fein
142 What’s On Your Mind: Status Update on Social Media
144 Assess, Document, Decide: How to Manage Liability for
Suicide Related Claims
Nicholas Bozzo, Ronald Zimmet
146 Suicide Prevention Resource Guide
Suicide Prevention From the Field
150 Dickinson Teaches Kids to ACT
151 Institute for Family Health Taps Into the Saving Power of
Neil Calman, Virna Little
152 Manatee Glens Runs for Hope
154 Nebraska Says There is No End Without Means
Denise Bulling, David Miers
154 PEMHS Adopts a Well-Rounded Approach to Avert Crises
Thomas C. Wedekind
155 Riverside Trauma Center Goes to School for Suicide
156 Rushford Ensures SAFE-T for Persons with Substance Abuse
Olga Dutka, Michelle Maloney
158 Senior Reach Assesses for Suicidal Ideation in Older Adults
David Bartsch, Liz Smith
Don’t Be Afraid to Ask:
The Mental Health First Aid
Copyright ©2012 - Askesis Development Group Inc. All Rights Reserved.
Leading the Way
6 / NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2
The Smoking Gun in
Linda Rosenberg, MSW, President and CEO, National Council
for Community Behavioral Healthcare
Before this year comes to an end, another one million people around the
world will die by suicide.We have all heard what drives people to take their
own lives — psychiatric and substance use disorders, stressful life events, and
chronic pain are often listed.
But there’s another risk factor that’s rarely mentioned, even though it accounts
for more than half of the suicide deaths in the U.S.each year.That culprit is guns.
Some may argue that guns are merely the methods used for suicide,like drown-
ing or suffocation. However, a review of statistics and scientific studies finds
that guns are not only a popular means of suicide, but that access to firearms
is strongly associated with the increased risk of suicide.
A study in 2007 by researchers at the Harvard School of Public Health found
that people who live in areas with high concentrations of guns are more likely
to die by suicide. The study, which accounted for factors like poverty, sub-
stance use, and mental illness, looked at the 15 states with the highest firearm
ownership and found that twice as many people committed suicide compared
to those in the six states with the lowest firearm ownership. Published in The
Journal of Trauma, the study concluded that “the ready availability of firearms
is likely to have the greatest effect on suicide rates in groups characterized by
more impulsive behavior.”
That “impulsive behavior” the researchers referred to is what makes guns a
death sentence for people intent on killing themselves.The Harvard study found
that while firearms are used in only 5% of suicide attempts,they are responsible
for more than 50% of suicide deaths because of their 90% fatality rate. Many
of the most widely-used suicide attempt methods have fatality rates below 5%.
A 2002 study in the Journal of Epidemiology and Community Health found that
attempts involving firearms were 2.5 times more lethal than those involving
suffocation — the second most lethal form of suicide.
Guns leave little hope for the thousands of people who survive suicide attempts
every year and manage to turn around their lives. People who swallow pills,
inhale fumes,or slash their wrists have some time to reconsider their desperate
actions. Even if they are not rescued, these methods often fail, leaving open the
hope that they will seek treatment.But with a firearm,once the trigger is pulled,
there’s no turning back.
You don’t often see “suicide” and “gun control” in the same sentence, but the
facts are too overwhelming to ignore. Not only is death by firearms now the
fastest growing method of suicide, but guns are even used in more suicides
There’s no doubt in my mind that people who have less access to guns are less
likely to commit suicide. While gun owners reportedly keep a firearm in their
home for “protection” or “self-defense,” 83% of gun-related deaths in these
homes are the result of a suicide, often by someone other than the gun owner.
I encourage you to use World Suicide Prevention Day on September 10 and
Suicide Prevention Week, September 9–15, as a time to speak up about guns
and suicide. Contact your legislators, inform your members, and issue a state-
ment to the media about the issue of guns and suicide.
Now is indeed the time to bring gun control into our conversations on suicide.
Those served by National Council member organizations are often the most
likely people to consider suicide and to take their own lives — they are looking
to us for leadership, and counting on us to take action.
Linda Rosenberg has more than 30 years of mental health policy and practice experience,
focusing on the design, financing, and management of behavioral health services. Since 2004,
Rosenberg has been President and CEO of the National Council for Community Behavioral
Healthcare, a not-for-profit advocacy and educational association of nearly 2,000 organizations
that provide treatment and support services to 8 million adults and children with mental illnesses
and addictions. Under Rosenberg’s leadership, the National Council has more than doubled its
membership; helped to secure the passage of the federal mental health and addiction parity law;
expanded financing for integrated behavioral health/primary care services; proved instrumental
in bringing behavioral health to the table in federal healthcare reform; and played a key role in
introducing the Mental Health First Aid public education program in the United States.
With a firearm, once
the trigger is pulled,
there’s no turning back
On January 7, 1995 my life and world changed forever.That was the day my older brother killed himself. I felt as though someone snuck up behind me
with a two-by-four and smacked me on the back of my head and I was leveled. My belief system, my faith, and my foundation cracked and tumbled down
inside of me.I wasn’t even sure if I still loved my brother when he died and I was devastated.All I could think about was how his wife,children,and friends
It was then I realized that suicide was no longer an option and now, I had no choice but to live.
I have struggled with suicidal thoughts since childhood and there were many times when I started to prepare myself to die.I even aborted an attempt when
I realized I would be found in time and would survive.When my brother died,I had a plan,a back-up plan,and a back-up plan to the back-up plan — I was
not going to survive. But now I had to live because I knew that whatever my brother was thinking before he killed himself — like we’d be better off without
him or we’d get over it — he was wrong. It was his disease or suicidality talking to him and not the truth.
If it applied to him, it had to apply to me.This forced me to get help and stick with it until I found the right therapist and the right medication. I learned
that for me,thinking about suicide was like a drink is to an alcoholic and I had to treat it like a chronic disease.I learned that I have to be vigilant and do
my best to maintain a healthy lifestyle. I learned to have a safety plan. Most important, I learned to find someone I trust — my husband — to talk to when
I start to feel overwhelmed or suicidal.There’s something almost magical about verbalizing the thought without fear of being hospitalized — it takes away
the power and intensity of the thought and helps me to see outside myself and seek other options.
As a family member who’s lost a loved one to suicide and a survivor myself, I got involved in suicide prevention. I realized I couldn’t talk about getting
rid of the stigma and shame associated with suicide without self disclosing.We won’t start talking about it unless we start talking about it! I’ve written
articles and pamphlets and speak openly about my struggles with suicide and I have no intention of stopping.There are times when I wonder if that’s why
I can’t get that temporary or part-time job or what my neighbors must think if they Google me — but if that’s the price I must pay, then I’ll gladly pay it.
I pray that by sharing my experience, strength, and hope I am helping others to conquer their suicidality.
Heidi Bryan founded the Feeling Blue Suicide Prevention Council, (www.feelingblue.org) a nonprofit organization based in Pennsylvania, after losing her brother
Jeff to suicide. She was awarded SPAN USA’s Sandy Martin Grassroots Award in 2005. Heidi was chair of the Pennsylvania Adult/Older Adult Suicide Prevention
Coalition (www.PreventSuicidePA.org) with which Feeling Blue Suicide Prevention Council recently merged. She is a QPR Master Trainer and a speaker. Heidi is
a member of the National Suicide Prevention Lifeline Consumer Survivor Subcommittee and the National Action Alliance for Suicide Prevention Suicide Attempt
Survivor Task Force. She is the author of Must Be the Witches in the Mountains, a book about grief after suicide.
I’ll Gladly Pay the Price
Into the Light
Stories of Courage and Hope
8 / NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2
David Covington, LPC, MBA,Vice President,Adult & Youth
Services, Magellan Health Services and Board Director,
National Council for Community Behavioral Healthcare
Michael Hogan, Commissioner, New York State Office of
Co-leads, Clinical Care & Intervention Task Force,
National Action Alliance on Suicide Prevention
Not Another Life to Lose
The Bridge to Zero
Shift in Perspective From To
Accepting suicide as inevitable Every suicide is preventable
Stand alone training and tools Overall systems and culture change
Specialty referral to niche staff Part of everyone’s job
Individual clinician judgment & actions Standardized screening, assessment, risk stratification, and interventions
Hospitalization during episodes of crisis Productive interactions throughout, continuity of care
“If we can save one life…” “How many deaths are acceptable?”
NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2 / 9
October 2013 marks the 50-year anniversary of President Kennedy’s Community
Mental Health Act, providing us the opportunity to celebrate the recovery of
millions of individuals who have benefited from community care.These individuals
have successfully crossed the bridge we’ve collectively built that leads to a stron-
ger life in community, away from the institutional settings, despair, and disability
that could result without our care.
Tragically, our community care “bridge” has seen the suicide deaths of too many
seeking an end to their deep pain.Another iconic bridge — the Golden Gate Bridge
— marks its 75th year in 2012. It too, must grapple with suicide — 1,500 deaths
have occurred from its rails since the first in 1937. Perhaps like the world of com-
munity care, the bridge authority has seemed ambivalent about suicide. Interven-
tion was relegated to a niche group of trained security staff, while most leaders
focused their attention on their core business.
Attitudes are changing. In 2006, the documentary “The Bridge” included footage
of 22 individuals jumping to their deaths over the course of a year and included
interviews with family, friends, and bystanders.The film included an interview with
Kevin Hines who survived a jump in 2000. In the documentary Kevin intimately
describes the last five seconds.In the first second,he would do anything to end the
all-consuming despair he felt from his struggle with bipolar disorder — including
flinging himself across the rail. In the subsequent 4-second fall, he instantly real-
ized he would do anything to undo what seemed too late to change.
This film — released during a time when knowledge of suicide prevention was
emerging — ignited a remarkable change.The bridge authority took responsibility,
and voted to install a plastic-coated,steel safety net underneath the entire span of
the bridge.Where similar safety interventions have been implemented, the suicide
rate has been driven to near zero. We understand that for those who might have
died — like Kevin Hines — suicide was not inevitable. Safety precautions could
make a difference.
The parallels for community behavioral health are striking. While our nation’s
suicide prevention efforts have focused on people at high risk for decades, the
public’s attention has been largely on teens, college students, returning veterans,
and people in high-risk minority communities.These groups can face suicide rates
2 to 4 times greater than the general population. By comparison, individuals with
serious mental illness die by suicide at rates 6 to 12 times higher (especially
those with major depressive disorder, schizophrenia, bipolar disorder, borderline
personality disorder, and anorexia) than the general population. Our bridge has
not been very safe.
Like the Golden Gate Bridge with its trained security, we have relied on a small
group of specialized staff to confront the highest risks. These frontline leaders
include crisis interventionists who work in crisis centers, hotlines, or mobile crisis
teams. Many may have taken on this mission because someone in their life died
by suicide. However, despite the high risk among the people we care for, the bulk
of the behavioral healthcare workforce has not received dedicated training in how
to help people who are acutely suicidal.We often feel unprepared for the frequent
encounters where suicidal thoughts are introduced. We learned that hospitaliza-
tion was required when people are suicidal. As a result, therapeutic relationships
characterized by trust and candor were shaken when individuals were ferried to
someone else because they spoke the “S-word,” whether to specialized staff, a
psychiatrist, an ER employee, or law enforcement officer.
Now Is the Time
In 2010, we were asked to lead a task force on suicide intervention and care for
healthcare systems.A statement from SAMHSA’s Bureau Chief for Suicide Preven-
tion,Dr.Richard McKeon,set the tone for a different approach:“Over the decades,
there have been many instances where individual [mental health] clinicians have
made heroic efforts to save lives… but systems of care have done very little.”
Over the course of 2011, our task force learned that some systems of care have
taken a different path.We studied the results of the USAir Force in the late 90s,the
Henry Ford Health System,the National Suicide Prevention Lifeline and theArizona
Programmatic Suicide Deterrent System,and we developed a report,“Suicide Care
in Systems Framework.”
The fundamental message was that we must do more than offer clinical staff pe-
riodic trainings, or vanilla exposure to evidence-based practices. We must take
responsibility as leaders. Saving lives starts with culture change, and leverages
the resources of our systems.We must commit to safety — both the safety of those
we serve and a safe environment for clinical staff, who may experience bad out-
comes despite their best efforts.Just as we have committed to change the 25-year
Where similar safety interventions have
been implemented, the suicide rate
has been driven to near zero.
10 / NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2
premature death that results from our consumers’ medical illnesses, we must
commit to helping them stay alive despite the desperation and isolation that
can be fatal. We must define suicide intervention and care as a core business
competency and expectation for community behavioral health.
The leaders of Henry Ford Health System ignited a fire in our task force, and ef-
forts in Arizona and New York were followed by initiatives in Texas, Kentucky and
Pennsylvania.We have a growing learning collaborative of behavioral healthcare
leaders who strongly believe suicide represents a worst case failure in mental
health care and that we must work to make it a ‘never event’ in our programs
and systems of care.
What Can You Do?
Our task force is working to develop a series of web-based modules that will
support your efforts, to be available beginning in spring 2013.These tools and
materials will be available through the Suicide Prevention Resource Center web-
site at www.sprc.org:
1. Changing your core business (mission/vision for zero suicide in healthcare)
2. Adopting/leveraging a safety and performance improvement culture
3. Orienting/training the workforce for suicide intervention and care
4. Installing proven suicide prevention practices including screening for risk,
pathways to care, interventions that are effective against suicide and follow-
up after acute treatment.
We recommend you start with a leadership dialogue and make a commitment
and then survey your entire workforce for self-perceptions on skill, training, and
support to engage in the important work of suicide prevention. Unless your ex-
perience is very different than ours to date, you will likely find that at least half
do not feel they are adequately equipped.About one in four behavioral health
professionals have experienced someone under their care ending their life, with
resulting concern and possible guilt — or commitment.
The 2010 Forbes magazine article “The Forgotten Patients” chastised the men-
tal health industry for ignoring the over 35,000 people who die by suicide each
year. Now is the time for behavioral healthcare to move suicide intervention
and care to core business, to equip staff to engage in this important work, and
to communicate to those we serve an end to the “don’t ask, don’t tell” culture
In 2001, Henry Ford Health System’s behavioral healthcare leaders and staff
committed themselves to this new approach with their “Perfect Depression
Care” initiative. Within four years, the suicide rate had declined by 75% and
more recent results have been stunning.A 2012 national study from the UK pub-
lished in The Lancet also demonstrated positive declines in suicide for health
districts implementing comprehensive reforms.
We are convinced that we must engage in this work and that we can succeed.
We know much more than we did just a decade ago—when Surgeon General Dr.
David Satcher released the first National Strategy for Suicide Prevention as a
follow-up to his pathbreaking report on mental health.We have new tools that
can much more accurately predict risk,and clinical interventions as well as sys-
tems approaches (e.g. follow-up after Emergency Room visits) that dramatically
reduce risks.We have learned from survivors of suicide attempts that the will to
live remains strong even after things seemed impossible.Indeed,many survivors
are becoming our strongest and most effective advocates.
Now is the time when leadership will make a difference. And no mission is
more important than saving lives. Please join with others to make our bridge
to recovery safer.
As Vice President for Adult & Youth Services for Magellan of Arizona, David Covington is respon-
sible for the administrative, financial, programmatic, and clinical oversight of the system of care
which serves 80,000 actively enrolled individuals who are struggling with mental illness and/or
substance abuse issues in central Arizona through a vibrant network of more than 100 specialty
behavioral healthcare provider agencies. Covington is a founding Executive Committee member of
the National Action Alliance on Suicide Prevention and co-lead of the Clinical Care & Intervention
Task Force. He is a member of the Board of Directors of the National Council for Community
Behavioral Healthcare, a member of the Magellan of Arizona Community Governance Board, the
acting chair for the SAMHSA National Suicide Prevention Lifeline Steering Committee, and Past
President for the NAMI Arizona Board of Directors. Previously, Covington was CEO and Partner for
Behavioral Health Link, whose groundbreaking Georgia Crisis & Access Line has been recognized
for innovation and excellence from SAMHSA, the National Council, CARF’s Promising Practices,
Council of State Governments, State News magazine, Business Week, and Harvard’s Kennedy
School of Business.
Dr. Michael Hogan was confirmed in March 2007 as Commissioner of Mental Health in New
York.The New York State Office of Mental Health operates 25 accredited psychiatric hospitals
and oversees New York’s $5 billion public mental health system that serves 650,000 individuals
annually. Dr. Hogan served as Director of the Ohio Department of Mental Health (1991-2007)
and Commissioner of the Connecticut Department of Mental Health (1987-1991). He chaired the
President’s New Freedom Commission on Mental Health in 2002-2003 and was appointed as the
first behavioral health representative on the board of The Joint Commission in 2007. He served
(1994-1998) on the National Institute of Mental Health’s National Advisory Mental Health Coun-
cil, as President of the National Association of State Mental Health Program Directors, and as
Board President of NASMHPD’s Research Institute. He has received leadership awards from the
National Governor’s Association, National Alliance on Mental Illness, Campaign for Mental Health
Reform,American College of Mental Health Administration, and American Psychiatric Association.
Individuals with serious mental illness
(especially those with major depressive
disorder, schizophrenia, bipolar disorder,
borderline personality disorder, and anorexia)
die by suicide at rates 6 to 12 times higher
than the general population.
90%of people who die by
suicidehave a diagnosable
and treatable psychiatric disorder
at the time of their death.
(American Foundation For Suicide Prevention)
When it comes to suicide prevention, EveryDay Matters. In recognition of National Suicide
Prevention month, we thank those who work in a community that takes action every day.
Visit www.EveryDayMatters.comto share your story and help debunk the stigma
often associated with mental health.
12 / NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2
Not Another Life
to Lose :
Suicidal Thoughts and Behavior
among Adults Aged 18 or Older
THOSE AT HIGHERST RISK NEED FOCUSED INTERVENTION
Rates greater than general popultion
White Males 65+
Individuals with Serious Mental Illness(SMI)
Lesbian, Gay, Bisexual,
1.1 Million Attempted Suicide
8.7 Million Reported having serious thoughts
0.1 Million Made No Plans and
2.5 Million Made Suicide Plans
1.0 Million Made Plans and Attempted Suicide
Preventing suicide is everyone’s business. As members of a
family, a school, business, neighborhood, faith communities,
friends, and our government, we all need to work together
to solve this problem. I ask everyone to help by learning
about the symptoms of mental illnesses and substance
abuse, the warning signs of suicide, how to stand with and
support someone who is in crisis, and how to get someone
you care about the help they need.
Surgeon General Dr. Regina Benjamin
Every 15 minutes a person dies by suicide in the US
Suicide is the second leading cause of death among
25-34 year olds and the third leading cause of death among 15- to
24-year olds. Almost 16% of students in grades 9 to 12 report having seriously
Among the 1.1 million adults who attempted suicide in
the past year, 752,000 (67.2%) received medical attention
for their suicide attempt in the past year, and 572,000
(51.1%) stayed overnight or longer in a hospital as a
result of their suicide attempt in the past year.
Adults in 2010 who were unemployed in the past year were more
likely than those who were employed full time to have serious
thoughts of suicide (6.7 vs. 3.0%), make suicide plans (2.6 vs. 0.6%),
and attempt suicide (0.9 vs. 0.2%).
Suicide Rates per 100,000 population
by County, United States 2000–2006
Suicide is the 2nd most common cause of death
in the U.S. military The 154 suicides for active-duty
troops in the first 155 days of 2012 outdistance the U.S.
forces killed in action in Afghanistan by about 50 percent.
1 out of 6 students nationwide
(grades 9-12) seriously considered
suicide in the past year.
Among college students there are a
reported 1,100 suicides per year and
50% of college students report suicidal
ideation at some time in life.
Worldwide, suicide accounts for $26.7 billion in combined
medical and work-loss damages yearly and a majority of
violence-related injury deaths (64%).
2 million adolescents
attempt suicide annually,
resulting in 700,000 ER
There are 25 attempts for every death by suicide
for the nation; 100-200:1 for the young; 4:1 for the elderly
Lesbian, gay, bisexual and trans youth are
4 times more likely, and questioning
youth are 3 times more likely, to attempt
suicide as their non-LGBT peers.
Compared with adults with private health insurance, adults
with Medicaid or CHIP had higher rates of serious thoughts of
suicide (6.7 vs. 3.1%), making suicide plans (2.9 vs. 0.8%), and
attempting suicide (1.6 vs. 0.4%).
700,000 ER visits
NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2 / 13
90% of individuals
who die by suicide have
untreated mental illness
— of these, 60% have
Under-treatment of mental illness is
pervasive — 50-75% of those in need
receive no treatment or inadequate
treatment; 50-75% of children with
depression go undiagnosed and untreated
Mental disorders, particularly mood disorders, schizophrenia,
anxiety disorders and certain personality disorders
Alcohol and other substance use disorders
Impulsive and/or aggressive tendencies
History of trauma or abuse
Major physical illnesses
Previous suicide attempt
Family history of suicide
Job or financial loss
Loss of relationship
Easy access to lethal means
Local clusters of suicide
Lack of social support and sense of isolation
Stigma associated with asking for help
Lack of health care, especially mental health and substance
Cultural and religious beliefs, such as the belief that suicide is
a noble resolution of a personal dilemma
Exposure to others who have died by suicide (in real life or
via the media and Internet)
Are some at greater
risk than others?
Of every 100,000 people in each
of the following ethnic/racial groups
below, the following number died
by suicide in 2007.
Feeling like you want to die or to kill yourself.
Feeling trapped or like you cannot handle the pain.
Feeling hopeless or like you have no reason to live.
Looking for a way to kill yourself, such as searching for methods
online or buying a gun.
Feeling like you can’t talk to anyone and would rather be alone.
Drinking more alcohol and using drugs.
Feeling like you are a burden to others.
Sleeping too little or too much.
Feeling anxious or agitated.
Wanting to seek revenge.
Having extreme mood swings.
Restricted access to highly lethal means of suicide
Easy access to a variety of clinical interventions
Effective clinical care for mental, physical and substance use disorders
Strong connections to family and community support
Support through ongoing medical and mental health care relationships
Skills in problem solving, conflict resolution and handling problems in
a non-violent way
Cultural and religious beliefs that discourage
suicide and support
Report Suicidal Content at
Veterans Crisis Line
NFL Life Line
The Trevor Helpline
For more information, interviews, and research on suicide check out
the National Council’s magazine edition on the topic
50-75% untreated Nearly one-half of the people
who die by suicide have seen a
primary care physician within a month
of death. Primary care visits may represent an
important opportunity for suicide prevention.
Protective Factors for Suicide
Risk Factors for Suicide When to Call a Suicide Prevention Lifeline
Leading the Way
14 / NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2
They’ll Be Glad They Lived
Action Alliance Brings New Focus to Suicide Prevention Efforts
John M. McHugh, Secretary of the Army
The famed French philosopher Voltaire once la-
mented that“the man who,in a fit of melancholy,
kills himself today,would have wished to live had he
waited a week.”A powerful figure in Europe’s Age of
Reason,Voltaire’s views on suicide today may seem
simplistic, even trite. But the point of identifying
opportunities to intervene and helping someone
choose a different path remains as relevant as ever.
Of all afflictions facing mankind, suicide remains
one of the most vexing. There are few, if any, early
warnings — no sneezes,coughs,or fevers.It can’t be
readily diagnosed, x-rayed, or surgically removed. It
is not confined to a race, gender, age or socioeco-
nomic status. And perhaps most frustrating of all,
its sufferers need do only one thing to keep it from
taking hold — absolutely nothing at all. To wait, as
Voltaire once advised, just one more week.
For the U.S. military, suicide seems particularly in-
sidious.TheArmy is an institution that works hard to
instill in its members the Warrior Ethos, a code our
soldiers live by — never accept defeat, never quit,
and never leave a fallen comrade. Yet, for all our
effort,we now lose more service members to suicide
than to combat.
On average, 95 Americans take their lives each day
by suicide.On average,one of them will be a soldier.
It’s logical to assume that in the military,the stresses
and strains of more than a decade at war — repeat-
ed deployments, extended time away from family,
and the rigors of combat — are the reason we see so
many promising lives lost so early. But like so many
of suicide’s contradictions, while assumptions are
often easy, reality is a far more complicated affair.
A 3-year study by the Department of Defense re-
vealed that 54% of those who took their own lives in
2010 had never deployed to theater. Similarly, 59%
of those who had attempted suicide were never sent
to war. As Secretary Leon Panetta recently noted,
these facts clearly demonstrate that “we’re deal-
ing with broader societal issues. Substance abuse,
financial distress, relationship problems, the risk
factors for suicide that also reflect the problems in
the broader society, the risk factors that will endure
Secretary Panetta’s observations are further sup-
ported by statistics from the Center for Disease
Control, which show a troubling increase in both
the number and rate of suicide deaths across the
United States. The CDC’s last comprehensive study
revealed that between 2001 and 2009, the rate of
suicide death increased nearly 10% (from 12.48%
to 13.68% per 100,000) while the number of re-
sulting deaths rose more than 20% (from 30,600
In recent years, the Army has dedicated a great
amount of effort and resources into our own sui-
cide studies,prevention,and intervention programs.
Nevertheless, we believe that the road to truly
meaningful progress lies in collaboration amongst
the private sector, public institutions, and experts
from all walks of life.
That’s why I’m privileged to serve, along with former
U.S. Senator Gordon Smith, as co-chair of the Na-
tional Action Alliance for Suicide Prevention.
Since its inception on World Suicide Prevention
Day in 2010, the Alliance has created a unique
public-private partnership, with deep and diverse
leadership on its executive committee and advi-
sory groups. Alliance members also represent ap-
proximately 200 different organizations nationwide,
bringing them together in a collaborative effort.
In the short time since its standup, the alliance
created fourteen Task Forces. Some will improve re-
search and understanding of suicide within specific
demographic groups,while others tackle broader is-
sues facing society as a whole — helping us better
define and understand our challenges.
One of the Alliances goals has been the update of
the National Strategy for Suicide Prevention, the
first revision since its release in 2001. A renewed
NSSP will facilitate our efforts to create healthy and
empowered individuals and communities; promote
clinical and community preventive services; target
treatment and support; and improve data collection
In our quest to identify new ways to intervene and
ultimately prevent suicide, a better understanding
of the warnings, root causes, and at-risk popula-
tions will be essential. For example, while suicide
is the third leading cause of death among young
people,middle aged women have been identified as
the fastest growing at-risk population. In short, we
must broaden our thinking, abandon any quest for
one-size-fits-all solutions, and recognize a simply
reality — while we all face our own challenges, we
share a common threat.
With more than a dozen goals and 60 objectives,
the NSSP is a substantive and necessary document,
encouraging dialogue and sharpening our focus to-
Suicide is often described as a permanent solution
to a temporary problem.Helping those at risk better
understand they have options, support, and hope
may make them choose to wait, for at least for one
more week. Then, as the famed philosopher once
noted, they’ll be glad they lived.
John M. McHugh was sworn in as the 21st Secretary of the
Army on Sept. 21, 2009, following his nomination by President
Barack Obama and confirmation by the United States Senate.
As Secretary of the Army, he has statutory responsibility for all
matters relating to the United States Army. Secretary McHugh
is responsible for the Department of the Army’s annual budget
and supplemental of over $200 billion. He leads a work force
of more than 1.1 million active duty,Army National Guard, and
Army Reserve soldiers; 221,000 Department of the Army civil-
ian employees; and 213,000 contracted service personnel.At
the time of his appointment as Secretary of the Army, McHugh
was a sitting member of Congress representing Northern and
Central New York. During his nine terms in the U.S. House of
Representatives, he earned a reputation as a staunch advocate
for soldiers and their families, working tirelessly to ensure they
had proper facilities, training, and the quality of life necessary
to carry out wartime missions while caring for those at home.
95 Americans take their
lives each day by suicide.
On average, one of
them will be a soldier.
Sunday, March 27, 2011 was going to be a fun day highlighted by my family’s (wife
and four children) participation in the local NAMI walk to raise mental health
recovery awareness.We woke up early to go out for breakfast prior to the event and
my wife nervously informed me thatAlly,our 15-year-old,was not responding to her
best efforts to rouse her. I hurriedly entered Ally’s bedroom to find her barely able
to make responsive moans and unable to open her eyes.Without thinking,I hoisted
her 95-pound frame over my shoulder, ran to the car, and drove faster than I had
ever previously dared to the emergency room.
We learned later that Ally had taken a potentially lethal combination of Phenter-
mine – Xanax – Vicodin – Ambien – Ibuprofen in an attempt to end her life. She
remained in the hospital for four days in a semi-coma, recovering from a heart
attack and short-term neurological damage that prevented her from walking. The
doctor told us she was lucky to be live and indicated that it was good to be 15 and
healthy, because most other people wouldn’t have made it.
Four days is a long time to examine what had just happened. We were confused,
angry, frustrated, sad, worried, scared, and lost. How does this happen to parents
in the behavioral health field? I have been involved with Magellan’s CentralArizona
Programmatic Suicide Deterrent System Project. I had been leading a suicide pre-
vention workgroup for two years.This should not be happening to me!
Why would my little girl — who liked to dance, read, watch movies, incessantly text,
and hang out with her family — want to end her life? What were we missing? She
didn’t appear depressed or withdrawn. She wasn’t rebellious. She wasn’t the type
of teenager that wanted to go to parties, the mall, or stay out late.
We decided to admit her into a children’s behavioral health inpatient setting after
discharge. Our insurance would pay for 10 days of treatment. We were so scared
about her being home that we would have preferred for her to stay 10 months.We
just wanted her to be safe.These 10 days gave us the opportunity to safely explore
the real issues — prescription pain killer abuse; boys/sex/relationships and rejec-
tion; sexting,shame,feelings of inadequacy; obsession with“dark,nihilistic”music
and movies; the expectation to be perfect in our eyes.Ally would rather end her life
than face her parent’s rejection. Suicide was a logical option to get her out of her
perceived predicament. I was stunned by the “fearlessness” she exhibited when
discussing her rationale for attempting suicide.
I was so scared for Ally to come home and worried that she would try again. I
read about a woman who was so determined to keep her suicidal daughter alive
that she removed all the doors in the house and had the daughter sleep with her,
tethered by a string. I didn’t want to go that far, but I was willing to take the steps
necessary to reduce any risk of suicidal behaviors.
Once we arrived home with Ally, we tried to remove any influences that might in-
crease suicidal thoughts. We took Ally out of public high school and she started
taking online classes via home computer.She was only allowed to call friends — no
texting or cell phone. Friends could come over to the house and visit, but she was
not allowed to go out on her own at first.No social activities without parents/family
involved.We limited music to positive selections.Prescription drugs were locked up
out of reach.As I write this, it sounds like house arrest, but it allowed Ally to focus
on her recovery without distractions.
Ally started counseling — she didn’t really want to discuss all of her issues with
us and we didn’t press her. She joined ballet classes at a studio at least 5 days a
week.And she started working out daily with her mother at a gym.
We increased family activities — movie outings,zoo,bowling,etc.— prioritizing this
time together and scheduling it like any other appointment.I started spending time
with Ally — we hiked Camelback Mountain together.We went to the bookstore and
just talked — nothing deep, just about life.
The most important thing we did was be involved.We tried not to play therapist,but
offered our unconditional love. Ally needed to hear that we wanted her in our life
and that we would be there for her no matter what. We changed, too. We learned
how to cope with this force that was trying to take our daughter away from us.We
became better listeners and tried not to overreact.We gave more hugs, held more
hands, and said more “love you’s”.
Maybe we were the lucky ones, but Ally started to slowly rebuild herself. She began
friendships with those in her dance classes and online program. She started think-
ing of herself as a dancer and it became a passion. She became best friends with
her 13-year old brother.She became so much closer to her family.She is now think-
ing about what she wants to do after high school this year.Maybe she will be a pro-
fessional dancer; maybe she will go to college and study to be a physical therapist.
I am hopeful that Ally is headed in the right direction.This experience has changed
me in such a profound way, that I am hopeful that I am headed in the right direc-
tion as well.
Chris Damle is the Senior Director of Adult Services, Quality of Care for Magellan Health Services of Arizona. He has been serving adults with a serious mental
illness for the past 25 years. He is currently leading a suicide prevention workgroup to incorporate social connectedness as a behavioral health treatment practice
for adults with a serious mental illness.
We Gave More Hugs
Into the Light
Stories of Courage and Hope
Leading the Way
16 / NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2
On September 10, 2012 the National Action Alliance for Suicide Prevention,
along with the U.S. Surgeon General, Dr. Regina Benjamin, released the revised
National Strategy for Suicide Prevention. The revised strategy emphasizes the
role every American can play in protecting their friends, family members, and
colleagues from suicide. The Surgeon General talks to National Council Maga-
zine about the highlights.
NATIONAL COUNCIL: Why is suicide prevention a key part of your agenda as
DR.BENJAMIN: Because nearly a hundredAmericans die by suicide every single
day, and in the past year, more than 8 million Americans had serious thoughts
For me, personally, a number of years ago, just as I was about to take over as
the first African-American and the first woman president of our county medical
society inAlabama,I was speaking on the phone with our executive director on a
Friday afternoon, and then we were supposed to speak again on Monday morn-
ing. But after I didn’t hear from him, I started calling him and calling around,
and I learned that on that Friday night he went upstairs, went into the closet,
and shot himself.And to this day I ask myself what could I have done and what
should I have done? And so if I as a doctor didn’t know, I’m not surprised that
others don’t either.
NATIONAL COUNCIL: What does the revised National Strategy for Suicide Pre-
vention focus on?
DR.BENJAMIN:The revised strategy shows us how individuals and communities
can come together to put processes and programs into place that can help peo-
ple like my former executive director.Ten years ago my predecessor, Dr. Satcher,
released the first National Strategy for Suicide Prevention. He started a new
conversation about suicide in America, making people aware of the problem.
Since then, the suicide prevention community has been trying to tell everybody
who would listen that more than 33,000 people take their lives in the United
States every year.And that’s one person every 15 minutes! Now it’s time for us
to turn our conversation to true prevention.
From a national perspective, I guess the biggest advancement that we’ve had
in the field is the launch of that National Action Alliance for Suicide Prevention.
And this particular alliance is a public and private coordinating body,and it was
called for in the 2001 strategy. It was actually formed two years ago, and prior
to that we had multiple groups and organizations spread out trying to address
the issue of suicide separately, but this Action Alliance brought us all together
and think about suicide in one place.We’ve had several hundred people who’ve
been involved in the effort of trying to revise the 2001 strategy.
We also wanted to make sure that our suicide prevention strategy aligned well
with our overall National Prevention and Health Promotion Strategy that I re-
leased in 2011 as U.S. Surgeon General and Chair of the National Prevention,
Health Promotion, and Public Health Council.
The revised suicide prevention strategy will guide the nation to prevent the bur-
den of suicide and suicidal behavior.We hope to use it over the next ten years.
This strategy captures the progress that we’ve already made,the knowledge that
we’ve acquired, and the promise that certainly was in our grasp.The promise is
that suicide is preventable.
We’ve had a lot of activity in the field of suicide prevention since that 2001 first
report. Government agencies at all levels, schools, nonprofit organizations, and
businesses have started to address suicide prevention. We enacted a law, the
Garrett Lee Smith Memorial Act, and that law established the National Suicide
America’s Doctor Says Connection is Prevention
Regina M. Benjamin, Surgeon General
Exclusive interview by Meena Dayak for National Council Magazine
Dr. Regina M. Benjamin, MD, MBA, is the 18th Surgeon General of the United States.As America’s Doctor, she provides the public with
the best scientific information available on how to improve their health and the health of the nation. Dr. Benjamin also oversees the
operational command of 6,500 uniformed public health officers who serve in locations around the world to promote, and protect the
health of the American People. From her early days as the founder of a rural health clinic in Alabama – which she kept in operation
despite damage and destruction inflicted by hurricanes Georges (1998) and Katrina (2005) and a devastating fire (2006) – to her
leadership role in the worldwide advancement of preventive healthcare, Dr. Benjamin has forged a career that has been recognized
by a broad spectrum of organizations and publications.
The promise is that
suicide is preventable.
NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2 / 17
Prevention Lifeline,and we’ve also established a Suicide Prevention Resource Cen-
ter.We’ve started increasing trainings and community awareness programs.
We’ve had some major developments in research and practice, such as an in-
creased understanding of the link between suicide and other health issues like
mental illness and substance abuse and traumatic or violent events.We also know
that being connected makes a big difference — connected to family, teachers,
coworkers, community organizations, and social institutions.And these things can
help protect individuals from a wide range of health problems including suicidal
risk.And we have evidence now that certain prevention and intervention strategies
like behavior therapy and crisis lines are effective.
We want to foster public dialogue.We want to counter the shame and the prejudice
and the silence, and we want to address the needs of certain groups that we know
are more vulnerable than others.We want to integrate public health and behavioral
health so that we can ensure continuity of care. Basically making system changes.
We also want to reduce the access to lethal means for people at risk of suicide.
The bottom line is that we want people to talk about it. Don’t be afraid to ask.
When you think somebody may be at risk, ask them,“Are you thinking about hurt-
ing yourself? Are you thinking about killing yourself?”We used to be afraid to ask
because we thought we’d be giving suggestions, but the research shows now that
asking and actually talking about it — communicating — is more important, and
that people will at least think someone cares enough to ask.
We also want people to know what the warning signs are — like people talking
about wanting to die, talking about feeling trapped, being in unbearable pain,
being a burden to others. Have they been looking for a way to kill themselves?
Are they becoming withdrawn and isolated with extreme mood swings? And if you
see somebody who has these warning signs and you think they may be at risk, it’s
very important that you don’t leave that person alone, that you stay in contact with
them or make sure somebody else is in contact with them,and remove any objects
that they could use to harm themselves.
Then you can call the National Suicide Prevention Line at 1-800-273-TALK and a
professional will tell you what steps to take next.And if all that fails, take them to
the emergency room where you can get some help.
It’s a simple thing — we’re trying to get people to understand that when someone
asks for help, you can get them help.You don’t have to be trained in it, you don’t
have to be an expert or a medical person. Basically you just show them that you
care. Many people who are suicide survivors will say,“Somebody cared enough to
It’s not one person that can stop a suicide, it’s going to be the whole community —
the workplace, schools, teachers — everyone getting together and making it okay
to talk about it, making it okay to get rid of the silence, get rid of the prejudice.
NATIONAL COUNCIL:You said being connected is a key prevention strategy — does
technology help with that?
DR. BENJAMIN: Technology is sort of a double-edged sword, as you know. Many of
our young people,— 16% of high school students — said they had serious thoughts
about suicide. They’re often on the Internet, on Facebook. And so that’s one of
the reasons we teamed up with Facebook — to be where the at-risk people are,
to reach them where they are. They have a button on the Facebook page, and if
you see a posting of a friend that seems to have the warning signs and you’re
concerned that they may be having suicidal thoughts, you can forward that posting
to the National Suicide Prevention Lifeline and a professional will contact that
person, either by email or by telephone, and take it from there.
NATIONAL COUNCIL: What can healthcare providers do to support suicide preven-
DR. BENJAMIN: Linking up medical care with mental health services, and trying to
get people into care with good follow up is really important.The Centers for Medi-
care and Medicaid Services also announced that they’re adding reimbursements
for clinicians’ offices that will do suicide screenings. We’re having more funding
going toward training of clinicians — physicians and nurses and their office staff —
so that we’ll have better identification and early treatment. The main thing now is
continuity of care — that we continue the care, that we don’t have it piecemeal
and separated from regular medical care, that we link the two together.
I’d just like to say thank you to behavioral health providers for the work that’s been
done over the years, the awareness. It’s hard work. It takes a lot for the providers
and clinicians to work with people who are at a point where they consider harm-
ing or killing themselves. I’d like to thank them for all the work that they’ve done
over the years and continue to do, and to let them know that they are very much
We also know that being connected makes
a big difference — connected to family,
teachers, coworkers, community
organizations, and social institutions.
Leading the Way
18 / NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2
Awareness Voices of
holds its first national
memorial in St. Paul,
opens in Los
NATIONAL MILESTONES IN SUICIDE PREVENTION
Institute of Mental
for Studies of
1968: First national
suicidology held in
1973: NIMH publishes
Suicide Prevention in
1976: AAS establishes
crisis center certification
program and certifies its
first crisis center.
Department of Health
and Human Services
Report of the
Force on Youth
1989: AAS holds its
first “Healing After
1990: SAVE is
1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984
Source: U.S. Department of Health and Human Services (HHS),
Office of the Surgeon General and National Action Alliance for Suicide
Prevention. 2012 National Strategy for Suicide Prevention: Goals and
Objectives for Action.Washington, DC: HHS, September 2012.
NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2 / 19
1992: Centers for
Network USA (SPAN
1996: World Health
Guidelines for the
1996: CDC publishes
report on suicide
1996: U.S. Air Force
passes S. Res. 84
and H. Res. 212
suicide as a
1997: The Jason
for Attempters and
Survivors of Suicide
1998: The Trevor
People of Color
1998: SPAN USA
and CDC partner to
host the Reno
1998: CDC funds
at University of
of Suicide Day
Call to Action to
2000: The Jed
2001: Substance Abuse and Mental
Health Services Administration
(SAMHSA) funds national crisis line.
2001: HHS publishes National
Strategy for Suicide Prevention.
2002: Institute of
Reducing Suicide: A
2002: The first Out
of the Darkness
Overnight walk held.
Care in America.
Working Group on
Act signed into law.
2007: The Veterans
Safety Goals on
one of its standards
signed into law.
Force on the
Members of the
2010: National Action
Alliance for Suicide
Strategy for Suicide
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
2010: SPRC and SPAN
Charting the Future of
Suicide Prevention: A
2010 Progress Review of
the National Strategy
for the Decade Ahead.
Leading the Way
20 / NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2
Suicide Prevention IS Everybody’s Business
The New National Roadmap to Action
Jerry Reed, PhD, MSW,Vice President, Education Development
Center and Director, Suicide Prevention Resource Center
Co-lead, National Strategy for Suicide Prevention Task Force,
National Action Alliance on Suicide Prevention
More than 15 years ago, the World Health Organization and the United Na-
tions published Prevention of Suicide: Guidelines for the Formulation and
Implementation of National Strategies. This publication called for a national
coordinating body to advance suicide prevention in each country. On Septem-
ber 10, 2010, that coordinating body, the National Action Alliance for Suicide
Prevention (Action Alliance), was launched in the United States, as a public-
private partnership by the U.S. Health and Human Services Secretary, Kathleen
Sebelius,and the Defense Secretary,Robert Gates.The Honorable John McHugh,
Secretary of theArmy,assumed the public sector lead of theActionAlliance,and
the Honorable Gordon H. Smith, President and CEO of the National Association
of Broadcasters, agreed to serve as the private sector lead.The Action Alliance
set out on its mission to champion suicide prevention as a national priority,
catalyze efforts to implement high priority objectives of the National Strategy
for Suicide Prevention (National Strategy), and cultivate the resources needed
to sustain progress.
One of the first concrete steps the Action Alliance took was launching the Na-
tional Strategy for Suicide Prevention Task Force.The mission of this task force
was to update and revise our nation’s suicide prevention strategy, which was
originally published in 2001.The Surgeon General, Regina Benjamin, and I were
nominated to be the task force co-leads.
During the very early stages of this effort,we knew that the first thing we needed
to do was to identify stakeholders and take the time to listen to them and ben-
efit from their viewpoints and perspectives. Our task force worked diligently to
obtain input from a broad array of stakeholders by stimulating and coordinating
dialogue, because our aim was to ensure that the revised strategy would reflect
input from as many stakeholders and perspectives as possible and be a docu-
ment that represented the science,the times,the field,and the many opportuni-
ties which exist to advance suicide prevention and save lives.
We came together as a group and reviewed the input thoroughly — it soon
became clear that major changes needed to be included, such as the addition
of resources for groups with increased suicide risk and the creation of an action
oriented approach, conveying what each of us might do to prevent suicide.We
also made the decision to align the National Strategy for Suicide Prevention
with the National Prevention Strategy: America’s Plan for Better Health & Well-
ness, launched by the Surgeon General Regina Benjamin in June 2011, and
organized the document into four strategic directions:
>> Healthy and empowered individuals, families, and communities
>> Community and clinical preventive services
>> Treatment and support services
>> Surveillance, research, and evaluation
We knew early on that we wanted a document that would be strategic in di-
rection and stimulate planning and actions by both public and private sector
stakeholders at multiple levels. As we launch the revised National Strategy for
Suicide Prevention, I feel we have been able to achieve just that.The new strat-
egy is written to appeal to a broad base, addresses public and mental health,
and builds on advances made since 2001.It carries the message that suicide is
preventable and, with multi-sectoral engagement, we can:
>> Foster positive public dialogue; counter shame, stigma, and silence; and
build public support for suicide prevention.
>> Address the needs of vulnerable groups, be tailored to the cultural and situ-
ational contexts in which they are offered, and seek to eliminate disparities.
We all have a role to play in advancing
suicide prevention and the revised
National Strategy for Suicide
Prevention is our roadmap.
NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2 / 21
>> Be coordinated and integrated with existing efforts addressing health and
behavioral health, and ensure continuity of care.
>> Promote changes in systems, policies, and environments that will support and
facilitate the prevention of suicide and related problems.
>> Bring together public health and behavioral health.
>> Address both risk and protection.
>> Reflect the latest science, as well as evidence-based and best practices/
To ensure an action-oriented approach, the strategy also outlines specific actions
that everyone can take to prevent suicide. It calls on businesses and employers,
schools, colleges and universities, community, non-profit, and faith-based orga-
nizations, as well as individuals and their families. We all have a role to play in
advancing suicide prevention and the revised National Strategy for Suicide Preven-
tion is our roadmap.
As we launch the revised National Strategy for Suicide Prevention, I can’t help
but recall the dedication of our task force members, along with countless others,
who gave their honest and open input to create a national strategy that is current,
comprehensive, and impactful. The strategy launch on September 10, 2012, is
exactly two years after the launch of the Action Alliance and occurring on World
Suicide Prevention Day, which is sponsored by the International Association of Sui-
It is my hope that you will take the time to read the strategy (see page 22) and
identify those objectives where you can take concrete steps to ensure you are
providing state of the art care in your behavioral health settings to move suicide
prevention forward in the United States.Together, I know, we will continue to make
a difference and save lives.
Jerry Reed began serving as the Director of the Suicide Prevention Resource Center in U.S. in July
2008.Through this work he provides state and local officials, grantees, policymakers, interested
stakeholders and the general public with assistance in developing, implementing and evaluating
programs and strategies to prevent suicide.Additionally, Dr. Reed serves as the Director of the Center
for the Study and Prevention of Injury,Violence and Suicide overseeing a staff of 40. Prior to this
appointment, Dr. Reed served for five years as Executive Director of the Suicide Prevention Action
Network USA (SPAN USA) a national non-profit created to raise awareness, build political will, and
call for action with regard to advancing, implementing and evaluating a national strategy to address
suicide. He spent 15 years as a career civil servant working in both Europe and the United States
as a civilian with the Department of the Army developing, implementing and managing a variety of
quality of life programs including substance abuse prevention and treatment, family advocacy, child
and youth development programs, social services and the range of morale, welfare and recreation
Strategic Direction 1:
Healthy and Empowered Individuals, Families, and
GOAL 1. Integrate and coordinate suicide prevention
activities across multiple sectors and settings.
Objective 1.1: Integrate suicide prevention into the values, culture,
leadership, and work of a broad range of organizations and pro-
grams with a role to support suicide prevention activities.
Objective 1.2: Establish effective, sustainable, and collaborative
suicide prevention programming at the state/territorial, tribal, and
Objective 1.3: Sustain and strengthen collaborations across fed-
eral agencies to advance suicide prevention.
Objective 1.4: Develop and sustain public-private partnerships to
advance suicide prevention.
Objective 1.5: Integrate suicide prevention into all relevant health
care reform efforts.
GOAL 2. Implement research-informed communication efforts
designed to prevent suicide by changing knowledge, attitudes,
Objective 2.1: Develop, implement, and evaluate communication
efforts designed to reach defined segments of the population.
Objective 2.2: Reach policymakers with dedicated
Objective 2.3: Increase communication efforts conducted online
that promote positive messages and support safe crisis
Objective 2.4: Increase knowledge of the warning signs for
suicide and of how to connect individuals in crisis with
assistance and care.
GOAL 3. Increase knowledge of the factors that offer
protection from suicidal behaviors and that promote wellness
Objective 3.1: Promote effective programs and practices that
increase protection from suicide risk.
Source: U.S. Department of Health and Human Services (HHS), Office of the Surgeon General and National Action Alliance for Suicide
Prevention. 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action.Washington, DC: HHS, September 2012.
2012 National Strategy for Suicide Prevention
Goals and Objectives for Action
Leading the Way
22 / NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2
Objective 3.2: Reduce the prejudice and discrimination
associated with suicidal behaviors and mental and substance
Objective 3.3: Promote the understanding that recovery from
mental and substance use disorders is possible for all.
GOAL 4. Promote responsible media reporting of suicide,
accurate portrayals of suicide and mental illnesses in the
entertainment industry, and the safety of online content related
Objective 4.1: Encourage and recognize news organizations
that develop and implement policies and practices addressing
the safe and responsible reporting of suicide and other related
Objective 4.2: Encourage and recognize members of the
entertainment industry who follow recommendations regarding
the accurate and responsible portrayals of suicide and other
Objective 4.3: Develop, implement, monitor, and update
guidelines on the safety of online content for new and emerging
communication technologies and applications.
Objective 4.4: Develop and disseminate guidance for journalism
and mass communication schools regarding how to address
consistent and safe messaging on suicide and related
behaviors in their curricula.
Strategic Direction 2:
Clinical and Community Preventive Services
GOAL 5. Develop, implement, and monitor effective
programs that promote wellness and prevent suicide and
Objective 5.1: Strengthen the coordination, implementation, and
evaluation of comprehensive state/territorial, tribal, and local
suicide prevention programming.
Objective 5.2: Encourage community-based settings to imple-
ment effective programs and provide education that promote
wellness and prevent suicide and related behaviors.
Objective 5.3: Intervene to reduce suicidal thoughts and behav-
iors in populations with suicide risk.
Objective 5.4: Strengthen efforts to increase access to and
delivery of effective programs and services for mental and sub-
stance use disorders.
GOAL 6. Promote efforts to reduce access to lethal means of
suicide among individuals with identified suicide risk.
Objective 6.1: Encourage providers who interact with individuals
at risk for suicide to routinely assess for access to lethal means.
Objective 6.2: Partner with firearm dealers and gun owners to
incorporate suicide awareness as a basic tenet of firearm safety
and responsible firearm ownership.
Objective 6.3: Develop and implement new safety technologies
to reduce access to lethal means.
GOAL 7. Provide training to community and clinical service
providers on the prevention of suicide and related behaviors.
Objective 7.1: Provide training on suicide prevention to com-
munity groups that have a role in the prevention of suicide and
Objective 7.2: Provide training to mental health and substance
abuse providers on the recognition, assessment, and manage-
ment of at-risk behavior, and the delivery of effective clinical
care for people with suicide risk.
Objective 7.3: Develop and promote the adoption of core
and training guidelines on the prevention of suicide and related
behaviors by all health professions, including graduate and
Objective 7.4: Promote the adoption of core education and
guidelines on the prevention of suicide and related behaviors by
credentialing and accreditation bodies.
Objective 7.5: Develop and implement protocols and programs
for clinicians and clinical supervisors, first responders, crisis
staff, and others on how to implement effective strategies for
communicating and collaboratively managing suicide risk.
Strategic Direction 3:
Treatment and Support Services
GOAL 8. Promote suicide prevention as a core component of
health care services.
Objective 8.1: Promote the adoption of “zero suicides” as an
aspirational goal by health care and community support
systems that provide services and support to defined patient
2012 National Strategy for Suicide Prevention Goals and Objectives for Action continued
NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2 / 23
Objective 8.2: Develop and implement protocols for delivering
services for individuals with suicide risk in the most collaborative,
responsive, and least restrictive settings.
Objective 8.3: Promote timely access to assessment, intervention,
and effective care for individuals with a heightened risk for suicide.
Objective 8.4: Promote continuity of care and the safety and
well-being of all patients treated for suicide risk in emergency
departments or hospital inpatient units.
Objective 8.5: Encourage health care delivery systems to incor-
porate suicide prevention and appropriate responses to suicide
attempts as indicators of continuous quality improvement efforts.
Objective 8.6: Establish linkages between providers of mental
health and substance abuse services and community-based
programs, including peer support programs.
Objective 8.7: Coordinate services among suicide prevention and
intervention programs, health care systems, and accredited local
Objective 8.8: Develop collaborations between emergency
departments and other health care providers to provide
alternatives to emergency department care and hospitalization
when appropriate, and to promote rapid followup after discharge.
GOAL 9. Promote and implement effective clinical and
professional practices for assessing and treating those identified
as being at risk for suicidal behaviors.
Objective 9.1: Adopt, disseminate, and implement guidelines for
the assessment of suicide risk among persons receiving care in
Objective 9.2: Develop, disseminate, and implement guidelines
for clinical practice and continuity of care for providers who treat
persons with suicide risk.
Objective 9.3: Promote the safe disclosure of suicidal thoughts
and behaviors by all patients.
Objective 9.4: Adopt and implement guidelines to effectively
engage families and concerned others, when appropriate,
throughout entire episodes of care for persons with suicide risk.
Objective 9.5: Adopt and implement policies and procedures to
assess suicide risk and intervene to promote safety and reduce
suicidal behaviors among patients receiving care for mental
health and/or substance use disorders.
Objective 9.6: Develop standardized protocols for use within
emergency departments based on common clinical presentation to
allow for more differentiated responses based on risk profiles and
assessed clinical needs.
Objective 9.7: Develop guidelines on the documentation of
assessment and treatment of suicide risk and establish a
training and technical assistance capacity to assist providers with
GOAL 10. Provide care and support to individuals
affected by suicide deaths and attempts to promote healing and
implement community strategies to help prevent further suicides.
Objective 10.1: Develop guidelines for effective comprehensive
support programs for individuals bereaved by suicide, and promote
the full implementation of these guidelines at the state/territorial,
tribal, and community levels.
Objective 10.2: Provide appropriate clinical care to individuals
affected by a suicide attempt or bereaved by suicide, including
trauma treatment and care for complicated grief.
Objective 10.3: Engage suicide attempt survivors in suicide preven-
tion planning, including support services, treatment, community
suicide prevention education, and the development of guidelines
and protocols for suicide attempt survivor support groups.
Objective 10.4: Adopt, disseminate, implement, and evaluate
guidelines for communities to respond effectively to suicide clusters
and contagion within their cultural context, and support implemen-
tation with education, training, and consultation.
Objective 10.5: Provide health care providers, first responders, and
others with care and support when a patient under their care dies
Strategic Direction 4:
Surveillance, Research, and Evaluation
GOAL 11. Increase the timeliness and usefulness of
national surveillance systems relevant to suicide prevention and
improve the ability to collect, analyze, and use this
information for action.
Objective 11.1: Improve the timeliness of reporting vital records data.
Objective 11.2: Improve the usefulness and quality of suicide-
Objective 11.3: Improve and expand state/territorial, tribal, and
local public health capacity to routinely collect, analyze, report, and
use suicide-related data to implement prevention efforts and inform
Objective 11.4: Increase the number of nationally representative
surveys and other data collection instruments that include
questions on suicidal behaviors, related risk factors, and
exposure to suicide.
Leading the Way
24 / NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2
GOAL 12. Promote and support research on suicide
Objective 12.1: Develop a national suicide prevention research
agenda with comprehensive input from multiple stakeholders.
Objective 12.2: Disseminate the national suicide prevention
Objective 12.3: Promote the timely dissemination of suicide
prevention research findings.
Objective 12.4: Develop and support a repository of research
resources to help increase the amount and quality of research
on suicide prevention and care in the aftermath of suicidal
GOAL 13. Evaluate the impact and effectiveness of suicide
prevention interventions and systems and synthesize and
Objective 13.1: Evaluate the effectiveness of suicide prevention
Objective 13.2: Assess, synthesize, and disseminate the
evidence in support of suicide prevention interventions.
Objective 13.3: Examine how suicide prevention efforts are
implemented in different states/territories, tribes, and communi-
ties to identify the types of delivery structures that may be most
efficient and effective.
Objective 13.4: Evaluate the impact and effectiveness of the
National Strategy for Suicide Prevention in reducing suicide
morbidity and mortality.
2012 National Strategy for Suicide Prevention Goals and Objectives for Action continued
I am Kevin Hines, a speaker and advocate of living mentally well. I am also a recovering alcoholic.
My struggle with alcoholism began in high school where I would binge drink every weekend until
In May 1999, in my senior year of high school, I was diagnosed with bipolar disorder, type I, with
psychotic features. I had become terribly paranoid, manic, depressed and had horrific auditory and
visual hallucinations.At the time,I could barely read,write,speak or function.Extreme paranoia was
the first of my symptoms. I believed people followed me in order to hurt or kill me.
The mania presented itself in grandiosity — I felt I could go anywhere, be anyone, and do anything.
When I was 17, I believed that Steven Spielberg would, at any minute, show up at my house, con-
tract in hand, offering me the lead in his next major motion picture. I expected his arrival every day.
The hallucinations were voices in my head or visualizations of people or creatures that only existed
for me. The depression led me toward complete self-destruction — cutting myself and suicidal
One year after my diagnosis of bipolar disorder, I wrote a suicide note, and the following day —
September 25, 2000 — I attempted suicide by jumping off of the Golden Gate Bridge. I survived the
220-foot plunge, my body falling at 75 miles per hour, from a height of 25 stories up — two thirds
of the height of the Transamerica pyramid building in San Francisco.The impact of hitting the water
shattered three of my lower vertebrae lacerating some of my lower organs — yet I lived.
It took me a long time to heal physically and emotionally. I learned all I could about my illness
and worked hard to defeat it, eventually winning the battle with alcoholism and bipolar disorder. I
had my very last sip of alcohol on my 21st birthday. I stopped cold turkey, knowing how dangerous
Today,I fight every day to stay mentally,physically and emotionally well.I am now winning the battle
with only an occasional mental relapse. I work every day to spread the message of living mentally
well, the importance of preventing alcohol and drug use, anti-bullying, educating about wellness
in the workplace, and teen wellness by way of speaking publicly to domestic and international
Since my attempt to end my life, I have spoken to more than 300,000 people, and reached and
reached millions more in media campaigns.
My struggle is not limited to my experience,it is about all who suffer with mental afflictions.I believe
my story can help those who hear it because I have learned that every day we wake up is a good
day and every day is a gift.
To Those Who Give Us a Fighting Chance
I have bipolar disorder. I work diligently to stay mentally well. I
take my meds on as prescribed every day. I exercise daily. I eat
healthily most days. I also conduct very serene deep breathing
drills during panic attacks. I get great sleep nearly every night.
None of this work stops my symptoms from occurring for some
unrelenting and unsuspecting moments. I am happy and blessed
that my wife, who is a saint, is willing to put up with such a rigor-
ous battle. I sincerely appreciate every second of our time to-
gether. She’s been with me through five out of seven psychiatric
hospital stays in the last nine years.
No matter the stress she is under, my wife recognizes that some-
times she must do what is necessary to keep me safe. Her love
for me and mine for her is unmatched and unconditional. There
is nothing I could do through the illnesses destruction that would
push her away to the point of no return. She simply soldiers on
and fights this battle with me.And I thank God for her.
It is important to remember that everything we do in the throes
of mental illness affects those around us. Our significant others
and family members who love and care for us so very much.The
ones who catch us when we fall. The ones who give us a fight-
ing chance when everyone around them tells them to run in the
opposite direction. To those with such courage and compassion,
I speak for the mental health community when I write that we
forever thank you.
“Yesterday is history,
tomorrow is a mystery, and
today is a gift.”
Kevin Hines speaks to audiences internationally about living mentally well. As a suicide prevention and mental health advocate, he was most recently honored
with the 2012 Welcome Back Lifetime Achievement Award from Eli Lilly. He is one of 33 Golden Gate Bridge jump survivors. Less than 2% of those people who
have survived the jump, have regained full mobility as Kevin has. He is the sole survivor actively spreading the message of living mentally well and the prevention
of suicide. Kevin has spoken to more than 300,000 people about his experience. A prolific writer and speaker, Kevin has been featured in the film “The Bridge”
by Eric Steel and on Larry King Live, Anderson Cooper 360, Good Morning America, and Ireland’s Famed Tonight. He has just finished his memoir, Cracked…Not
Broken,The Kevin Hines Story, slated for publication in 2013. He often travels across the country to speak to members of the military and to veterans.
Life Is a Gift
Into the Light
Stories of Courage and Hope
Leading the Way
26 / NATIONAL COUNCIL MAGAZINE • 2012, ISSUE 2
SAMHSA Takes a Public Health Approach to Suicide
NATIONAL COUNCIL: Can you describe SAMHSA’s current focus on suicide pre-
vention — what are your biggest concerns and what kind of programs do you
have to address the issue?
HYDE: Well you know that SAMHSA has a number of strategic initiatives and
prevention is our number one strategic initiative. And within that prevention
initiative, suicide is one of the key focus areas.
Prevention of suicide has been a major effort for us over the last several years
but particularly in the last couple of years,we have stepped up the attention.We
have grant programs, the National Suicide Prevention Lifeline, and the Suicide
Prevention Resource Center. In the last couple of years, we worked to kick off,
with Secretary Sebelius and Secretary Gates’ help, the National Action Alliance
for Suicide Prevention. That has been an incredible public-private partnership
and we charged that group with upgrading or revising the ten year-old national
strategy on suicide prevention that Surgeon General David Satcher did ten years
ago. This Surgeon General, Regina Benjamin, has been the lead to revise that
document and it’s been an incredible effort.
National Council: Why did we need a revised national strategy?What worked
well or what didn’t, with the first national strategy for suicide prevention?
HYDE: That was a great effort and it began a lot of work, and much has been
done over the last ten years. In that period of time, we’ve learned a lot more
about techniques, about how to assess people, and about awareness issues.
We’ve learned a lot more about who is at risk and how to address some of those
high risk populations. We have more research around interventions. So there’s
a lot more that we know ten years later.There are also some things in the initial
strategy which were actually done and it was now time to say okay, what are
the next steps.
One of the things that was in the original strategy ten years ago was to create a
public-private partnership, an action alliance of sorts, to actually move beyond
talking about stuff and get on with actually doing things to prevent suicide
across the country. So updating the national strategy was one of the key things
that the NationalActionAlliance was charged with doing.TheAlliance was taking
a look at that 10 year-old document and asking what’s already been done,what
needs to be done, what’s new in there, what are the issues we need to focus
on now for the next decade. So we’re very pleased.That’s not the only thing the
Action Alliance has done. It’s been doing a ton of things over the last two years.
It was kicked off literally two years ago, on September 10.
National Council: Would you comment on the highlights of the new national
strategy from the Action Alliance?
HYDE: Making sure we address access to lethal means — whether that is medi-
cations in the medicine cabinet, guns in the house, or a bridge — for someone
who is at risk, is down the road. Looking at what those lethal means are for
people who are at risk, and seeing what we can do to prevent that is one of
There are goals on evidence based practices. So for example, we know that a
number of people who go into an emergency room, or into a hospital admission
because of a suicide attempt, are at very high risk of actually dying by suicide.
Making sure that we have coordination and collaboration so that those people
get follow-up care is a very high priority.
We’ve got a fair amount of work in the strategy around populations that are
at particularly high risk of either suicide attempts or suicide deaths. So the
Action Alliance has particular subgroups or taskforces on Native Americans, on
military families,LGBT youth,and other populations like that,and then there are
taskforces around particular sectors, like the faith-based sector.And then there
are also taskforces around research and taskforces around data issues and
things of that nature.I think there are about 200 people that are involved in the
taskforce efforts of the Action Alliance at this point.
Exclusive interview by Meena Dayak for National Council Magazine
Pamela Hyde was nominated by President Barack Obama and confirmed by the U.S. Senate in November 2009 as Administrator of the Substance Abuse and
Mental Health Services Administration, a public health agency within the Department of Health and Human Services.The agency’s mission is to reduce the impact
of substance abuse and mental illness on America’s communities. Hyde is an attorney and comes to SAMHSA with more than 30 years experience in management
and consulting for public healthcare and human services agencies. She has served as a state mental health director, state human services director, city housing
and human services director, as well as CEO of a private non-profit managed behavioral healthcare firm. In 2003 she was appointed cabinet secretary of the New
Mexico Human Services Department by Gov. Bill Richardson, where she worked effectively to provide greater access to quality health services for everyone. She
has been recognized by many groups, including the American Medical Association, the National Governor’s Association and the Seattle Management Association,
for her creativity and leadership in policy and program development and in organizational management issues.