Ted Simons: The national council for state governments recently honored the Arizona Health Department with a 2012 innovations award for the state's suicide deterrent system. The Arizona program targets those diagnosed with a serious mental illness a high risk group for suicides. Joining us now is Dr. Karen Chaney of the Magellan Health Services, a behavioral health agency that partners with the state on implementing the suicide prevention program. It's good to have you here. Thanks for joining us.
Dr. Karen Chaney: Thank you very much for having me.
Ted Simons: The award seemed like it was an all-encompassing award, but among the many things that were focused on was the idea of silence and stigma when it comes to suicide. Is that true?
Dr. Karen Chaney: Yes, that is very true. This award was given to both ADHS and Magellan because of their guidance in working with people with serious mental illness, and with general mental illness, but also for anyone in the community, because this is a community problem. Suicide is. And basically what they were looking for is innovations and new programs and different way of looking at this to reduce stigma and to help the individuals and the public.
Ted Simons: What were some of those innovations and programs?
Dr. Karen Chaney: It started out very simply as a training program for behavioral health providers. Because we found that they were not comfortable, believe it or not, in asking the correct questions or dealing with suicidal people. And it was uncomfortable. So when you're uncomfortable with something you're not going to say, oh, are you suicidal, and get the answers. And so basically they kind of tiptoed around it. And behavioral health workers aren't supposed to do that. So knowing this, and knowing that their discomfort with it, they needed training, and a training program that was developed was used in the Maricopa County. We have trained something like 3500 behavioral health care workers since the inception of this. It started with that, but it has grown immensely into being all-encompassing program. Which includes making sure that family members have knowledge about this, and also that they are engaged with their loved one who is suicidal, or has attempted suicide. We also are looking at the cultural aspects of it and making sure we're touching everyone. So we've got a diversity and inclusion group, so that we make sure that when we're talking with our Latino members, that we are asking the right questions and making sure that they're comfortable with talking about this.
Ted Simons: In terms of recognizing at-risk signs, what are some of those signs?
Dr. Karen Chaney: Well, at-risk signs, basically we always need to know when we meet someone for the first time is if they've ever tried to commit suicide in the past. That would mean they would be at more risk. They've had family members that have died by suicide. But we also look at what are they doing, do they have depressive signs and symptoms do, they have another diagnosis like schizophrenia or a bipolar disorder; which makes them more at risk Those people with those types of diagnosis are six to 12 times more likely to harm themselves. So we'll ask those questions also, and determine what the diagnosis is. But we also will check and say, are they isolating? Are they giving their things away, are they just talking just about -- I just wish I wasn't here? Do they have a desire to be -- to die, and do they have an intent or capability? Because someone who becomes fearless about suicide becomes more capable of doing it.
Ted Simons: Is it difficult to assess those risks when you get maybe an answer yes, answer no, maybe a little bit here, a little bit there? It's one thing to ask the questions, it's another thing to assess the risk.
Dr. Karen Chaney: Exactly. And it's such a good question, because what we have done is we have developed a program called driving suicides to zero, which is beginning its implementation here within Maricopa County. And basically what that involves is a screening; three similar many questions that we -- three simple questions we ask of adolescents and three simple questions we ask of adults, and we even have it for children, because children are also at risk. Once we get a positive screen, we go on to a risk assessment, and we stratify exactly how risky is it right now. Are they at acute risk, are they at moderate risk or low risk? It doesn't matter which it is, if they have any sort of risk, we will be doing lots of interventions to assist them so that they are not suicidal.
Ted Simons: Last question here -- Was it difficult to get some of these changes through, people who maybe weren't that comfortable asking direct questions, maybe some other round about questions. Did that help or was it still pushing a little bit of a boulder up a hill here?
Dr. Karen Chaney: I can tell you that when we developed this program, we had the community providers come in and we had probably 20 provider groups in there, 50 people, and we sat down and talked about the risk of suicide in our populations. And we decided we were going to do something. And they weren't afraid of doing that at all. It was quite a collaborative effort, it was really very rewarding to sit down and talk and come up with our screens, our assessments, and the resources that we have to help people.
Ted Simons: Very good. Congratulations on the award. Thank you so much for joining us.
Dr. Karen Chaney: Thank you. Appreciate it.