In 2017, Colorado had the tenth highest rate of suicide in the nation and approximately half of the suicides happened with firearms. When adolescents die by firearm suicide, over 80 percent use a gun belonging to a family member.
“Suicide is a major public health problem in Colorado and when someone is at risk of suicide, the safest option is to store guns away from their home temporarily,” said Sara Brandspigel, MPH, assistant director, Program for Injury Prevention, Education and Research at the Colorado School of Public Health. “Our goal with creating this resource is to improve community safety and prevent suicide by reducing the time it takes for people to find and reach out to local storage options, which is a challenging landscape to navigate.”
Partnership with Law Enforcement and Gun Shops
CU Anschutz faculty identified 15 law enforcement agencies and 47 gun shop owners around the state that currently offer out-of-home storage options, and they will continue to add new storage locations to the map. The storage map lists contact information to streamline the process of identifying storage options.
“Navigating the ever-changing legal landscape and looking for reasonable options for storage in a time of crisis can add a lot of stress to an already stressful situation,” said Jacquelyn Clark, owner of Bristlecone Shooting, Training & Retail Center. “We have room at our facility to house a moderate number of firearms just for storage purposes and are committed to being good community partners. It makes sense to offer our facility as a resource to families who may need temporary storage at an affordable rate.”
The online resource can also be used for a number of temporary firearm storage reasons, such as when traveling out of state, hosting visitors, selling a home, etc.
“Participation in the Colorado Gun Storage Map is another means of helping our community members, which can be accomplished so easily,” said Mark Heminghous, chief of police, Dillon Police Department. “We want to be able to offer people the ability to have some time away from their firearms if they need it. We hope people will take us up on the offer before they experience a crisis.”
The health policy brief, “Protecting Colorado Youth from Gun Violence,” reviews the impact of gun violence on youth in Colorado and across the nation. It notes that addressing the epidemic will require a multi-pronged approach. The brief assesses opportunities and potential legislation to protect Colorado youth from suicide, homicide and accidental gun death.
The report is the work of Jennifer Mijer, pediatric senior resident, and Shale Wong, professor of pediatrics and family medicine, in the CU School of Medicine.
For Frank DeAngelis, the “beloved 13” are never far away. They are with the retired Columbine High School principal when he speaks about school safety across the country, while he works as a consultant for safety and emergency management in Jefferson County, and the moment he wakes up in the morning.
“I refuse to become helpless and hopeless … each morning I recite the names of my beloved 13 and they give me the reason to do what I do,” DeAngelis said. “They gave me the reason to walk back into Columbine High School for 15 years after the tragedy.”
Although the Columbine shooting of 20 years ago represents one of the darkest days in Colorado history, a day-long symposium at the CU Anschutz Medical Campus on April 16 struck a hopeful and problem-solving tone. “Uniting to Prevent School Violence – 20 Years Since Columbine” drew more than 200 attendees and featured national experts on school violence, local politicians and leaders in law enforcement and mental and behavioral health.
In his introductory remarks, Matthew Wynia, MD, MPH, FACP, director of the Center for Bioethics and Humanities, said the tragedy of April 20, 1999, affected the entire country and rippled across the world. He said it forced Colorado to take a leadership role in helping others to learn how to prevent school violence.
‘Honor the legacy’
“Today our hope is to honor and respect the legacy of the tragedy at Columbine by coming together to learn and provide a forum for our state to help move forward the agenda to prevent such future incidents,” Wynia said.
The opening session featured keynote speaker Deborah Prothrow-Stith, MD, dean of the Charles Drew University of Medicine and Science and national expert on adolescent violence, and Colorado Lt. Gov. Dianne Primavera.
It was DeAngelis’ vivid recollections of that horrific day and its aftermath that evoked emotions from attendees.
The principal was in his office about to renew the contract of a first-year teacher when his secretary broke in with reports of gunfire. When he stepped into the hallway, “my worst nightmare became a reality because I encountered a gunman 75 yards away,” DeAngelis said.
The principal, the gunman and the key
He saw a group of girls walking into the same hallway, having just come from the locker rooms next to the gym. He ran toward the them and the gunman, urgently ushering the girls back down the hall toward the gym. “As the girls were screaming and the shots were ringing louder I reached in my pocket where I had a set of about 35 keys on a key ring,” he said. “The first key I pull out I stick in the door and it opens on the first try.”
The afternoon session began with a moving Art from Ashes poetry reading, an introduction from Attorney General of Colorado, Philip Weiser, JD, and former attorney general, Cynthia Coffman, JD, followed by a stakeholder discussion about the future direction for Colorado and our country.
In the panel discussion, Christine Harms, MS, director of Colorado School Safety Center, Department of Public Safety, highlighted the high teen suicide rate in Colorado and stated that it is a community issue, not just a school issue.
Susan Payne, founding director of Safe2Tell, stressed the importance of breaking down silos and creating a collaborative system of support at every school, including law enforcement and community members, as the majority of reports to Safe2Tell occur after school hours. All panelists agreed that the best way to put the research presented in the morning sessions into practice is to have young people be a part of the solution.
To this day, DeAngelis regularly receives photos from those girls – now women in their late 30s – showing off their growing families, their smiling children. “They say, ‘Mr. D, we’re so glad you found that key.’ … I’m not sure if I found that key. Someone found it for me.”
As mass shootings continue on a regular basis, DeAngelis and the thousands more who’ve been directly affected search for ways to prevent future senseless acts. The retired educator, who received a master’s degree from CU, noted that “so many lessons have been learned” over the 20 years, including improved response systems, crisis care and understanding of recovery for PTSD.
Back in 1999, he said, fire drills were the only emergency exercises held in school. “So that’s an important lesson learned – that we’re training for that day when something could happen at your school, at your church, at your mental facility.”
Much to learn from victims
Prothrow-Stith was among a group of leaders in the late 1970s who, alarmed by statistics that homicide was the leading cause of death for young black men and the second leading cause of death for all U.S. adolescents, set stage for addressing violence as a public health problem.
She said survivors of acts of mass violence are some of the best champions of solutions to the problem. “There’s a lot to learn from them, and the politicians listen to them when they don’t listen to the data.”
Prothrow-Stith offered several slides, including a study showing that states with stronger firearm laws have lower rates of suicide and homicide. Another study showed that motor vehicle fatalities have steadily dropped over the decades, corresponding to increased funding for automotive safety programs. Meanwhile, U.S. firearm fatalities continue to rise while safety-related funding remains low.
In 2015, for example, 33,800 Americans died in car accidents, and Congress approved $830 million for safety research. Meanwhile, 33,636 people died from gunshots that year while just $5 million was OK’d for gun safety research. “It seems we could have more of an impact if we had more collaborative, concerted funding focused on prevention (of firearm violence),” she said.
The matter of guns
Prothrow-Stith noted that there are almost twice as many suicides each year in the U.S. than homicides. “What we’re learning about guns and their participation in both homicide and suicide suggest that there are things we can do,” she said. “If I were to say where I’m probably the most frustrated it’s in our lack of ability … to address gun ownership in the U.S.”
She pointed out that New Zealand, where recent shootings at two mosques killed 50 people, has already banned semi-automatic weapons and assault rifles. In contrast, she noted, the U.S. has pro-violence cultural messaging that dates back centuries and it’s not changing. “I don’t know that we’ve released our children of the marketing of violence,” she said. “Now we’re marketing this thing called violence to girls as well.”
‘Colorado stands as a model for other states to look to when it comes to school safety.’ – Lt. Gov. Dianne Primavera
She admitted to reaching a point of being “almost withdrawn from this issue” when not even the devastating Sandy Hook Elementary School massacre in 2012 was enough to spur Congress to act. But the strong activist responses by students after last year’s Parkland, Fla., shooting, and the subsequent passage of a Florida gun bill, has renewed her optimism.
“When we think about hurt children hurting other children we really have to think about what we give as cultural messages, and of course we need to make the hurt go away,” Prothrow-Stith said. “But if we can share strategies for healing and handling the hurt better and healthier, rather than fighting or hurting oneself, I think we could make a dent in this.”
Primavera said Colorado has done much to improve school safety since Columbine, including:
Opening one of the largest School Safety Resource Centers in the nation, where more than 46,000 people have been trained on threat assessments, suicide prevention and child sexual abuse prevention.
Launch of the state’s Safe2Tell tip-line program, which has become a model for recognizing threats and responding quickly.
In 2013, the state passed universal background checks, resulting in “thousands” of people with criminal records being denied access to firearms.
In 2018, the Colorado Legislature approved $60 million in school safety grants.
Last week Gov. Jared Polis signed the Lifesaving Extreme Risk Protection Order into law. The legislation allows family members and law enforcement officers to request a court order to temporarily remove firearms from someone who is deemed a danger to themselves or others. Her mention about the new law drew a burst of applause from the audience.
“Colorado stands as a model for other states to look to when it comes to school safety,” Primavera said.
Emotions welled in the auditorium when DeAngelis read off the names of the 12 students and one teacher killed 20 years ago. He said his intent is to celebrate their lives. “As we go through the next four days, that’s what I want you to do. We’ll always remember the 13,” he said. “Columbine represents hope.”
Contributors: Sidebar story by Kiley Kudrna, photos by Matt Kaskavitch, Office of Communications
Speaking to a rapt audience of almost 5,000 in Denver, Matt Vogl covered more territory than what is usual in a brief TEDx talk. He went from an unflinching account of what led him to the brink of suicide 15 years ago to his desire to disrupt and innovate in the nation’s “snarled” mental health system to promising virtual-reality treatments for prisoners in Alaska and beyond.
Vogl recounted the highs of his standup comedian career, saying, “Even when it sucked, the comedy life was amazing: I was getting paid to make people laugh. And best of all, it provided the perfect cover for my misery. … I was really funny, and I was really miserable.”
‘My rock bottom’
He recalled a night of smash shows at the Comedy Works in Denver, then going home and researching ways to kill himself. “Eventually, it got so bad that I wrote a note and picked a date. And then I bought a gun.” He said a neighbor randomly intervened and saved his life that day.
“It’s crazy how close I came, but what’s even crazier is that almost dying by suicide wasn’t my rock bottom,” he said. “My rock bottom came when I tried to access care in our snarled mental health system.” He illustrated the U.S.’s broken care system by showing a photo of highway gridlock. Access to care is abysmal, misdiagnoses are common and medications often make the patient feel worse. Vogl said he bottomed out when a therapist fell asleep in the middle of a session — and had the nerve to ask for a copay.
Currently in the United States, 80 percent of people with a mental illness don’t receive adequate care, Vogl said. But building more clinics and hiring more providers won’t solve the crisis, he said. “We cannot clinic our way out of our mental health access problem.”
Access to mental health care
His goal as co-founder of the NMHIC, established 2-1/2 years ago, is to test news ways to make mental health services of all kinds more accessible to everyone — when they need it and even before they need it. The center brings together behavioral health experts and community resources to produce new strategies that advance care in Colorado and across the nation.
An example is a collaboration the NMHIC has forged with prisons in the northernmost state — at the request of the Alaska Department of Corrections. The department was struggling with mental health issues among many inmates, often exacerbated by Alaska’s extremely long and dark winters.
Vogl and a couple NMHIC colleagues introduced some of the inmates to VR technology. One inmate, behind bars for nearly 40 years, was transported to a sunny mountainside, leaving him in tears and saying, “I forgot what free felt like.”
Pilot program in Alaska prisons
The NMHIC launched a pilot program in three Alaska prisons to help inmates meditate. The plan is to integrate meaningful, personalized content for their virtual exposures. “A native inmate could meditate in the Inuit village where he grew up, or even participate in traditional ceremonies,” Vogl said. “We believe that over time this program can help us lower the use of sedating medications and solitary confinement.”
VR also shows promise in helping people overcome phobias, he said. For prisoners, this could help them transition to life on the outside — a prospect so frightening that it fuels a 70 percent recidivism rate.
VIRTUAL REALITY A HIT AT TEDx
The National Mental Health Innovation Center had a booth at the Bellco Theater lobby where the throngs of TEDx attendees could try virtual reality for themselves. More than 500 people participated in the demos, enjoying a relaxing tai chi experience, as well as being exposed to some of the meditation scenarios that are being piloted in Alaska prisons.
“We’re working with a New York-based startup firm to pilot test a series of VR experiences that enables inmates to learn critical skills to thrive on the outside. Things like resolving domestic conflict, or dealing with a job interview where the interviewer is grilling you about your time in prison,” he said. “Very often prisoners have some of the worst access to mental health services. So, if a solution works for them, there’s a good chance it will work for the rest of us — and it is.”
Technology isn’t the enemy
He showed a slide of his two sons, Mark and Sam, and said bipolar has a genetic component. He noted that people with untreated bipolar disorder have a 30 percent higher suicide rate than the general population, and “that scares me.” Prevention, early intervention and quick access to great care can lower those rates, Vogl said, motivating him to turn his fear into solutions.
“Technology isn’t the enemy of mental health. It’s a scalable solution,” he said. “I know because we’re seeing it work. In this life we can make life better — for me, for Mark and Sam, for inmates in Alaska and for everyone else caught in that bumper-to-bumper traffic.”
The U.S. has experienced a disturbing increase in violent and unintentional injuries over the last few years, reversing positive gains made in the 1980s and 1990s, according to a new study from researchers at the University of Colorado Anschutz Medical Campus and Denver Health Medical Center.
The study, published Wednesday in JAMA Surgery, examined the period between 2000 and 2016 and found that injury remains a leading cause of death in the nation.
“All injuries from gunshot wounds to car accidents have been going up,” said the study’s senior author Dr. Angela Sauaia, MD, PhD, of the Colorado School of Public Health at CU Anschutz and CU School of Medicine. “We saw a distinct spike between 2014 and 2016 that we can’t explain.”
Using a Centers for Disease Control data base known as WISQARS (Web-based Injury Statistics Query and Reporting System) the researchers showed that the jump in overall injuries from 2014-2016 reduced survival gains observed since 2001.
“Black non-Latinos retained the highest rate of homicide fatality rates across the entire period, and suffered the highest increase of all racial/ethnic groups during the 2014-2016 period,” the study said. “Similar patterns were observed for unintentional injuries and homicides.”
According to Sauaia, suicides appeared to increase steadily for white non-Latinos and black non-Latinos with a small but significant acceleration beginning in 2006. In comparison, white Latinos experienced a larger, significant increase in suicides starting in 2013. About half of suicides were firearm-related and those jumped from 2006 to 2016 after a six year decline.
Two-thirds of homicides were firearm-related.
“This subgroup observed the largest increase in the 2014-2016 period compared to all other injury mechanisms,” the study said.
Meanwhile, motor vehicle accidents also saw a serious increase from 2014-2016 following a decade of major declines. Overall, unintentional injuries spiked after 2014 for most age groups, except those 16 and younger.
Sauaia, a professor of public health and surgery, said the reasons behind all of this defy easy explanation. She noted that 2014 saw significant civil unrest in the U.S., including violent demonstrations over racial issues. Questions also surround the role social media plays in distracting drivers and causing more accidents, she said.
“What is disturbing to me is that we are talking about a major cause of death in our society and we have so little funding to do research for causes and solutions,” she said.
That doesn’t mean nothing can be done.
“There are some solutions we can start implementing. Regardless of where you stand on guns everyone agrees that children should not have access to loaded firearms,” Sauaia said. “And why not include as part of primary care, educating patients on firearm safety?”
As for motor vehicle accidents, she suggested that technology could be employed to make it more difficult to text and drive.
“These growing rates warrant concerted, decisive efforts by academia, society and policy-makers to support trauma-focused research,” the study concluded.
The study’s co-authors include Ryan Lawless, MD, of Denver Health Medical Center; Ernest Moore, MD, of the University of Colorado School of Medicine and Denver Health; Mitchell Cohen, MD, of the University of Colorado School of Medicine and Denver Health and Hunter Moore, MD, PhD, of the University of Colorado School of Medicine.
Fifteen teams received a realistic case-study about suicide prevalence, a public health issue especially relevant to Colorado. Each team had approximately 24 hours to analyze the case, create a public health solution and present it to a panel of judges.
The prizes for the top three teams were varying amounts of scholarship money up to $1,000. Three teams were chosen as the people’s choice recipients, with each member receiving $100.
“Public health stretches across all disciplines,” said Tonya Ewers, director of communications and alumni relations for the ColoradoSPH. “This is a great practice-learning opportunity for these students to learn to work together to solve health problems.”
This year’s winning team included three graduate public health students from the ColoradoSPH — two from its program at CU Anschutz and one student from their program at the University of Northern Colorado — as well a graduate student in pharmacy and another in nursing. Fitting for Veterans Day, their focus was on veteran suicide prevention with a project title of “Serve and Support: You Stood for Us, Now Let Us Stand for You.” Their project included media outreach ads and posters with grabbing headlines like “It’s Okay to Not Be Okay” and a peer navigation program that enrolls veterans at the time of discharge. Their case competition plan also included a mobile app and social media outreach to stay top of mind for veteran health.
First-place team member, Kacy Lorber (ColoradoSPH) posted photos of her experience on Instagram and said: “I got to present to so many important people but specifically two House Representatives in Colorado! The highlight was when state Rep. Dafna Michaelson Jenet told us that she got bill ideas from our presentations. I am so grateful for this experience.”
Diana Ir, current president of the case competition planning committee and student in the ColoradoSPH, participated in the competition last year.
“I had such a great experience,” said Ir. “I enjoyed it so much that I wanted to be a part of putting it together this year. I encourage everyone to participate in the future. Between the potential scholarship money and the awesome collaborative environment, you shouldn’t miss it!”
RESULTS – Rocky Mountain Regional Case Competition
1st Place ($1,000 each student scholarship)
“Serve and Support
You Stood for Us, Now Let Us Stand with You!
Comprehensive Veteran Suicide Prevention”
Team Members and Affiliations
Sujeith Barraza, ColoradoSPH (UNC home campus)
Phuong Banh, ColoradoSPH
Elizabeth Ko, Skaggs School of Pharmacy and Pharmaceutical Science
The National Behavioral Health Innovation Center announced today that Rick Rekedal, a former senior executive with DreamWorks Animation, and Dr. Walter Greenleaf, a pioneer and leading authority on virtual reality for medical use, have joined its staff.
“Walter and Rick are recognized internationally as leaders in their fields,” said Matt Vogl, executive director of NBHIC at the University of Colorado Anschutz Medical Campus. “Their knowledge and insight are powerful assets to our mission of finding bold new solutions to the country’s mental health crisis.”
In 2016, Rekedal completed over 20 years with DreamWorks as Chief Creative of franchise development and the global franchise director of the hit movie “Trolls.” Rekedal has also worked on properties such as “How To Train Your Dragon,” “Shrek,” “Kung Fu Panda,” and “The Lost World: Jurassic Park,” developing merchandising, interactive and licensing programs. Rekedal’s work has been recognized with two Annie Awards, two Kids Choice Awards and Toy of the Year. He is a frequent speaker and serves on advisory boards for The Wedgwood Circle; Michael W. Smith Group and Seabourne Pictures; and Belmont University’s film school.
Rekedal joins NBHIC as Senior Creative Advisor, consulting on how to elevate an open and urgent national conversation on mental health.
Greenleaf is a behavioral neuroscientist and a medical product developer who has been on the cutting edge of virtual reality and augmented reality applications in healthcare for more than 30 years.
In his role as NBHIC’s Director of Technology Strategy, Greenleaf brings his considerable knowledge to the Center’s approach to digital initiatives. He continues to work as a Visiting Scholar at the Stanford University Virtual Human Interaction Lab.
He has developed several clinical product streams, founded medical companies, and served as a scientific advisor and reviewer for the U.S. Public Health Service, National Science Foundation, National Institutes of Health, NASA and the U.S. Department of Education. He holds a PhD in Neuro and Bio-behavioral Sciences from Stanford University.
“Our approach is to seek out unexpected partners as we look beyond the current mental health system for new solutions,” said Vogl. “Walter and Rick fit that approach. Walter’s depth of knowledge in virtual reality and Silicon Valley are leading us to work with new technology partners in developing cutting edge tools for mental health treatments. Rick’s extraordinary creative abilities can help steer powerful human connections to combat the awful stigma that is so harmful to many people in need.”
Guest contributor: Lauren Baker, marketing and communications strategist for the National Behavioral Health Innovation Center at CU Anschutz.
The study, “Maternal Deaths from Suicide and Overdose in Colorado, 2004-2012,” found that of 211 maternal deaths, 30 percent were from self-harm, defined as suicide and nonintentional overdose deaths occurring during pregnancy and the first year after giving birth. In Colorado, the mortality rate from self-harm during the period was 9.6 per 100,000 live births. About 90 percent occurred in the postpartum period.
It is not known how the demographics and characteristics of maternal deaths in Colorado compare to other states or if such self-harm deaths are becoming more common. According to the study, in 2012 suicide was overall the most common cause of death in Colorado among those age 10 to 44.
“There is focus nationally on reduction in maternal mortality, and the majority of this effort has focused on in-hospital causes of death such as postpartum hemorrhage,” said lead author Torri Metz, MD, assistant professor of maternal fetal medicine at the CU School of Medicine. “As the Colorado Maternal Mortality Review Committee reviewed the maternal deaths in Colorado, we noticed that there was a large proportion of deaths from suicide and overdose. Our data supports that self-harm is in fact the leading cause of pregnancy-associated death in Colorado, which warrants our attention.”
The findings are published in the December edition of “Obstetrics & Gynecology.”
During the study period, 63 women died of suicide or a drug overdose. Of the 26 who died of suicide, asphyxia by hanging was the most common cause of death. In overdose deaths in which toxicology testing was performed at autopsy, opioids were the most detected class of drugs, chiefly pharmaceutical painkillers but also heroin.
Substance abuse and psychiatric disorders, most often depression, were present in a majority of the women with maternal deaths. However, no risk factor was present in 22 percent of the cases.
Although about half the self-harm cases were found to be taking prescription drugs for mental health care at conception, 48 percent stopped using the medications during pregnancy, in some cases with a care provider’s recommendation but in most without. During pregnancy, selective serotonin reuptake inhibitors (SSRIs) were the most commonly discontinued drug class alongside sleep aids, mood stabilizers and other antidepressants.
“This finding speaks to the importance of an informed discussion of the risks and benefits of continuing psychiatric medications during pregnancy,” Metz said. “Ideally this would occur prior to conception. The benefit of continuing medications, especially SSRIs in women with depression, frequently strongly outweighs the risk.”
Researchers also found that many of the women had documented social stressors, most notably unemployment (64%) or being single, divorced or separated (40%). Though such stressors, also including a history of domestic violence (18%) and unstable living situation (5%), were documented in a majority of the women, only one third engaged with a social worker either during prenatal care or at delivery.
During pregnancy and after delivery, woman at risk for self-harm may encounter health care providers such as social workers, nurses and physicians. Researchers say each point of contact with such women should be considered an opportunity for intervention throughout and after pregnancy. They suggest that raising awareness, better health screening, referrals for treatment of mental health and substance use disorders in pregnancy and recognition of the need for ongoing care beyond the early postpartum period is needed to reduce pregnancy-related deaths from self-harm.
Colorado’s newest center dedicated to improving mental and behavioral health has been established with a $10 million five-year commitment from The Anschutz Foundation, one of the largest program pledges in the history of the University of Colorado Anschutz Medical Campus.
The National Behavioral Health Innovation Center is housed at CU Anschutz in Aurora, but is designed as a “virtual center” to serve people in Colorado and across the nation, by identifying and implementing behavioral health solutions, making connections to national experts, and providing resources to build connections among community leaders across the state.
Matt Vogl is the executive director of the new National Behavioral Health Innovation Center
“There are few areas of health care more important and less understood than mental and behavioral health,” says CU President Bruce Benson. “By investing in a center with a focus on finding innovative approaches to prevention, identification and treatment through intensive collaboration with partners all across our state, The Anschutz Foundation is investing in a brighter future for all people who suffer from a behavioral health condition. We couldn’t be more grateful for their continued philanthropic partnership.”
“With this commitment, The Anschutz Foundation is hoping to help bring together resources and expertise to rapidly move the needle for mental and behavioral health in meaningful ways,” says Executive Director of The Anschutz Foundation Ted Harms. “We want to see the NBHIC become an example of what is possible when great minds band together to effect change, and, ultimately, to become a model for fostering the implementation of new and innovative approaches to behavioral health care across the country.”
Matt Vogl, MPH, has been named NBHIC executive director, reporting jointly to CU Anschutz Chancellor Don Elliman and to an NBHIC board of directors made up of prominent community, business, philanthropy and health care leaders who will guide the NBHIC’s work and ensure its relevance and sustainability into the future.
The NBHIC will engage the best minds across diverse industries in Colorado and nationally to help identify high-value focus areas for behavioral health innovation, identify subject matter experts, and assist in building community and organizational partnerships.
“Our vision for the NBHIC is to build a model for how people who suffer from mental illness or substance abuse should be treated as part of the health care continuum,” Vogl says. “To do so, we will work to become a state where stigma is absent, early identification and care is the norm, high-quality treatment is accessible to people in every community, and those in recovery get the support they need to return to a full and vital life.”
The NBHIC’s leadership is reaching out to community leaders to inform the center’s priorities and identify areas in which communities have developed innovative behavioral health solutions that warrant further exploration and possible expansion. Early interest is emerging in the design of employer-driven health promotion and coverage models, and in introducing the relevance of behavioral health to students entering diverse professions in business, education and other non-health care fields.
“The ongoing leadership of The Anschutz Foundation in the mental and behavioral health arena is inspiring,” says CU Anschutz Medical Campus Chancellor Don Elliman. “Our hope is that the NBHIC will help unite disparate efforts across our state and our region, and help accelerate progress by convening leaders and facilitating knowledge sharing. Together, we will usher in a new era of innovation in behavioral health.”
CU has some 61,000 degree-seeking students across its four campuses and another 8,000 taking courses for credit. The university graduates more students than any university in Colorado, about 14,000 last year. CU is well-positioned to lead efforts to integrate mental and behavioral wellness into the workplace and the classroom, and to share knowledge gained with others interested in following suit.
Despite national guidelines urging emergency department doctors to ask suicidal patients if they have access to firearms or other lethal implements, only about half actually do, according to a new study from researchers at the University of Colorado Anschutz Medical Campus.
The researchers interviewed 1,358 patients from eight emergency departments (EDs) in seven states who had either attempted suicide or were thinking about it.
“We asked the patients about their access to firearms and then reviewed their charts,” said the study’s lead author Emmy Betz, MD, MPH, from the University of Colorado School of Medicine. “We found in about 50 percent of cases there is no documentation by the doctor that anyone asked the patients about firearms access. That means there is a large group of patients we are missing a chance to intervene for.”
Some 25 percent of potentially suicidal patients who said they had guns at home kept at least one of them loaded and unlocked. Half of them had easy access to guns which put them at risk for future suicides.
According to the study, published in the latest edition of `Depression and Anxiety,’ emergency departments are a key setting for suicide prevention with 8 percent of patients admitted for either attempting suicide or having `suicidal ideation’ or thoughts of ending their own lives.
“Multiple ED visits appear to be a risk factor for suicide and many suicide victims are seen in the ED shortly before death,” the study said. “Based on models using national suicide statistics, ED-based interventions might help decrease suicide deaths by 20 percent annually.”
Still, previous studies suggest that ED doctors are skeptical about the effectiveness of such intervention and do not ask or counsel patients about their access to lethal means of ending their lives once they leave the hospital.
This study seems to confirm that.
“This rate of assessment falls short of national guidelines recommending that all suicidal patients receive counseling about reducing access to firearms and other lethal means,” Betz said. “Lethal means assessment is important for both overall risk assessment and for safety planning for patients being discharged.”
While it is difficult to control access to sharp objects, supplies for hanging and medication given their widespread availability, patients with easy access to guns are at an especially high risk.
Those who commit suicide often do so minutes after making the decision. And approximately 90 percent of firearm suicides are fatal compared to 2 percent of medication overdoses.
Betz said doctors could make a plan with the families of these patients. They could ask them to lock up firearms or remove them from the house for a period of time.
Some doctors are reluctant to ask patients about this because they don’t know if they should and if they do, what to do with the information.
“It is legal and appropriate to ask about this when it is relevant as it is in the case of suicide attempts or suicidal ideation,” Betz said. “Do it in a respectful, non-judgmental way and it will usually be well-received. Still, there isn’t a lot of training on this. As a result, we are missing the chance to save a lot of lives.”
The study was funded by the National Institute of Mental Health.