DNP 711 - Week 5:

INTRODUCTION/OVERVIEW: The History & Policy Process of Suicide Prevention Efforts in Arizona

Fully understanding the current problem of suicide in emerging, young adults in Arizona requires us to understand the history and policy process of past efforts to address suicide prevention and how they still influence the contemporary problem while also informing both current policy and future policy proposals. Influencing policy creation, government, private institutions, and actors work in concert with one another to affect the political, social, and economic systems as much as the other way around (Kingdon, 2003). The notion that government agencies and organizational actors lack a certain level of institutional autonomy in the policy process is as illusory as it is fallacious and fails to acknowledge the roots of power and influence within the rich heritage of new institutionalism theory (Kingdon, 2003; Greenwood et al., 2013). The long-dominant actors among health care institutions to influence policy development were typically hospitals (community and academic medical centers) (McLaughlin & McLaughlin, 2015). However, even that is now shifting as decentralization or distributed autonomous networking approach is occurring where that long-held process dominance continually erodes into an array of institutions that both deliver health care services and influence policy development. Some examples of decentralized actors acting as new policy players that exert influence are community health centers, specialty hospitals, large integrated systems (HMOs/ACOs), large multi-site practices, state/local government facilities, pharmaceutical companies, and various other actors or vendors (McLaughlin & McLaughlin, 2015). All of which leads us to a conclusion about public policy formation in that the processes are dynamic, fluid, loosely joined, and exceedingly complex (Kingdon, 2003). There are many conceptual frameworks (such as incrementalism, policy streams, stage-sequential, rational decision-making, and the advocacy coalition models) that the policy process consists of and aid in our understanding (Lindblom, 1979; Kingdon, 1995; Ripley, 1996; Longest, 1998, 2006; Weible, 2006). However, all follow the overall premise of increasing complexity, compounded by multi-directionality, and often unbounded by time and geographical proximity.

THE HISTORICAL PERSPECTIVE OF RELIGION & SUICIDE POLICY

Much of the historical underpinnings of suicide prevention globally and on a national level in the U.S. began with Emile Durkheim (1897), which connects prevention efforts to religious perspectives of suicidal behaviors (Mandhouj & Huguelet, 2016). Particularly in the three largest, monotheistic religions (Judaism, Christianity, and Islam), there is a universal condemnation of suicide as a sin and shameful behavior (Mandhouj & Huguelet, 2016). The irony of Durkheim's argument is that religious belief often moderates or mitigates suicide because of enhanced social cohesion and social integration (Durkheim, 2005, 2012; Mandhouj & Huguelet, 2016). Thus, religious affiliation and involvement often feature significantly negative associations with fewer deaths by suicide, suicide behavior, suicidal ideation, and tolerant attitudes toward suicide (Koenig et al., 2001; Dervic et al., 2004; Koenig, 2009).

U.S. NATIONAL & STATE OF ARIZONA POLICIES FOR SUICIDE PREVENTION

On a national level, the U.S. began suicide prevention efforts in the 1950s with increasing involvement in the issue through the 1980s (NAASP, 2012). Moreover, on the Arizona State level, suicide prevention efforts date back to the late-1980s with multiple taskforces commissioned (Governor's Office of Children, 1994; Office of the Governor, 2019). One of the most successful efforts at researching and furthering suicide prevention efforts at the state level in Arizona occurred in the 2000-2010s. Researchers analyzed the intervention effects of a surveillance system that compared the rates, numbers, and characteristics of suicide deaths and attempts during two related five-year periods (Cwik et al., 2016). The study provided evidence that the suicide surveillance and prevention system reduced suicide deaths and attempts, which was critical to prevention, intervention, and evaluation efforts while other national-level statistics remained unchanged or are increasing (Cwik et al., 2016). As we continue to look at multiple possible solutions for our growing public health crisis of suicide in the 21st-century, we should model our efforts after many successful approaches and should be cautious in allowing limitations on innovative problem-solving approaches. 

References:

Cwik, M. F., Tingey, L., Maschino, A., Goklish, N., Larzelere-Hinton, F., Walkup, J., & Barlow, A. (2016). Decreases in suicide deaths and attempts linked to the White Mountain Apache suicide surveillance and prevention system, 2001–2012. American journal of public health, 106(12), 2183-2189.

Dervic, K., Oquendo, M. A., Grunebaum, M. F., Ellis, S., Burke, A. K., & Mann, J. J. (2004). Religious affiliation and suicide attempt. American Journal of Psychiatry, 161(12), 2303-2308.

Durkheim, E. (2005). Suicide: A study in sociology. New York: Routledge Classics.

Durkheim, E. (2012). Suicide: A study in sociology. Gravesboro, CA: Snowball Publishing.

Governor's Office for Children. (1994). Adolescent suicide task force: Report and recommendations. Retrieved from http://azmemory.azlibrary.gov/digital/api/collection/statepubs/id/8477/download.

Greenwood, R., Oliver, C., Lawrence, T. B., & Meyer, R. E. (Eds.). (2013). The Sage handbook of organizational institutionalism. Thousand Oaks, CA; Sage Publications Ltd.

Koenig, H., Koenig, H. G., King, D., & Carson, V. B. (2001). Handbook of religion and health. New York: Oxford University Press.

Koenig, H. G. (2009). Research on religion, spirituality, and mental health: A review. The Canadian Journal of Psychiatry, 54(5), 283-291.

Lawrence, T. B. (2008). Power, Institutions and Organizations. In the Sage handbook of organizational institutionalism, (pp. 170-197). Thousand Oaks, CA; Sage Publications Ltd.

Mandhouj, O., & Huguelet, P. (2016). Why it is important to talk about religion. In Understanding Suicide (pp. 257-265). Switzerland: Springer International Publishing.

National Action Alliance for Suicide Prevention (NAASP). (2012). National strategy for suicide prevention: Goals and objectives for action: A report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention. Washington, D.C.: U.S. Department of Health & Human Services. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK109918/

Office of the Governor, Doug Ducey. (2019). Governor Ducey Signs Bill Combating Teen Suicide [Press release]. Retrieved from https://azgovernor.gov/governor/news/2019/05/governer-ducey-signs-bill-combating-teen-suicide