DNP 711 - Week 7:

INTRODUCTION/OVERVIEW: Public Sector Influences on Suicide Prevention Efforts in Arizona

The definition of public sector institutions refers to all of the agencies, offices, and other entities that constitute local, state, and federal governments (Hansen & Paul, 2019). As a bit of review from a previous blogpost that quintessentially introduced this week's subject matter, national-level suicide prevention in the U.S. began in the 1950s and increased through much of the 1980s (NAASP, 2012). From a state-level, suicide prevention efforts begin in the late-1980s and continue to influence policy efforts and topical study until our most contemporary effort of passing the Mitch Warnock Act in 2019 (Governor's Office of Children, 1994; Office of the Governor, 2019). Although several bills are pending during this current state legislative session that continues to address the issue of suicide prevention. However, currently, the most significant effort to align public sector influences and innovative efforts to aid in suicide prevention originate with the Mitch Warnock Act.

For example, the most immediate public sector institution that the Act impacts is the public education system by allowing and mandating educators to receive valuable suicide prevention training at minimum once every three (3) years (Office of the Governor, 2019). One immediate effect that this training requirement has is the direct increase in the promotion of suicide prevention and awareness campaigns. However, another practical impact that the Act has is that the mandatory training requirement also provides practical knowledge and skillset acquisition in recognizing critical warning signs of suicide behavior as well as the application of interventions to increase the efficacy of suicide prevention measures (AFSP, 2019; Office of the Governor, 2019).

Another public sector institution that the Mitch Warnock Act impacts is the Arizona Health Care Cost Containment System (AHCCCS), which is the state-level program or department that administers Medicaid benefits in Arizona (AHCCCS, 2018). Effectively, the Act orders that the suicide prevention training programs used to train and equip those public school educators and administrators adequately are selections determined sufficient by AHCCCS (Office of the Governor, 2019). As of July 2016, all behavioral health services in the state of Arizona moved from jurisdictional purview of the Arizona Department of Health Services to AHCCCS (AHCCCS, 2018). AHCCCS also manages and oversees the functional operation of the suicide hotlines and crisis resources for residents in Arizona (AHCCCS, 2016; AHCCCS, 2018).

CURRENT STATE OF ARIZONA LEGISLATIVE PROPOSALS FOR SUICIDE PREVENTION

During a recent policymaker interview with Jennifer Pawlik, an AZ State House Representative for District 17, we discussed a few of these pending measures or legislative proposals and their relation to the potential impacts that might affect other public sector institutions (Pawlik, 2020). For example, during our February 22nd, 2020 meeting, we discussed HB 2646, which would create a ripple effect throughout the justice system elements of Arizona as they are responsible for criminal prosecutions of violations of Arizona Revised Statutes - A.R.S. § 13-1103. HB 2646 effectively proposes that intentionally advising a minor to commit suicide with knowledge the minor will follow through with the advice as manslaughter (HB 2646). We discussed HB 2764, which would affect the Arizona Department of Insurance (DOI) as they enforce mental health parity (MHP) by establishing the MHP Advisory Committee, the Suicide Mortality Review Team, and the Children's Behavioral Health Services Fund (HB 2764). HB 2764 could potentially impact multiple public sector institutions other than the DOI, such as AHCCCS, AZDHS, and the Arizona Department of Education (ADE). Finally, we also discussed SB 1446, which would impact ADE directly by requiring them to increase awareness of mental health issues in young people (SB 1446a). Specifically, SB 1446 requires student identification cards to include contact information for suicide prevention resources, local crisis centers, or emotional support services (SB 1446b). All of these pending legislative proposals have potential impacts on at least one but likely multiple agencies or public sector institutions, which may also result in a substantial number of unknown secondary effects that might occur in the future with the implementation of passed and adopted legislation.

Arizona is beginning to position itself as a robust progressive state in dealing with and furthering our path forward for suicide prevention efforts. However, substantial work remains before us to ensure our continued progression. We must continue to work diligently on this issue, and passing some of these legislative proposals continues to build that momentum for other additional future gains in policymaking.

References:

American Foundation for Suicide Prevention. (2019). State laws: Suicide prevention in schools (k-12). Retrieved from http://afsp.org/wp-content/uploads/2019/06/AFSP_K-12-Schools-Issue-Brief_6-7-19.pdf

Arizona Coalition for Suicide Prevention and the Arizona Health Care Cost Containment System (AHCCCS). (2018). An end to suicide in Arizona 2018 state plan. Retrieved from https://tst.azahcccs.gov/AHCCCS/Downloads/2018StatePlantoEndSuicide.pdf

Arizona Coalition for Suicide Prevention and the Arizona Health Care Cost Containment System (AHCCCS). (2016). An end to suicide in Arizona 2016 state plan. Retrieved from https://archive.azahcccs.gov/archive/Resources/ADHS%20DBHS%20Guides%20Manuals/State%20Suicide%20Prevention%20Plan/State%20Suicide%20Prevention%20Plan.pdf

Arizona. Legislature. House of Representatives. 2020 Second Regular Session. HB 2646: Manslaughter; Suicide Assistance; Violation. Phoenix, 2020. Retrieved from https://www.azleg.gov/legtext/54leg/2R/summary/H.HB2646_022020_CAUCUSCOW.pdf

Arizona. Legislature. House of Representatives. 2020 Second Regular Session. HB 2764: Mental Health Omnibus. Phoenix, 2020. Retrieved from https://www.azleg.gov/legtext/54leg/2R/summary/H.HB2764_022420_CAUCUSCOW.pdf

Arizona. Legislature. Senate. 2020 Second Regular Session. SB 1446a - SB 1446: Student Identification Cards; Suicide Prevention. Phoenix, 2020. Retrieved from https://www.azleg.gov/legtext/54leg/2R/bills/SB1446S.pdf

Arizona. Legislature. House of Representatives. 2020 Second Regular Session. SB 1446b - Fact Sheet for SB 1446: Student Identification Cards; Suicide Prevention. Phoenix, 2020. Retrieved from https://www.azleg.gov/legtext/54leg/2R/summary/S.1446ED.pdf

Hansen, K, and Paul, N. (2019). Information strategies for communicators: Public sector institutions. Retrieved https://open.lib.umn.edu/infostrategies/chapter/6-2-public-sector-institutions/

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.

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

Pawlik, J. (2020, February 22nd). An interview with an Arizona elected official/Interviewer: A. Cromar. Doctor of Nursing Practice 711 Assignment, Arizona State University, Phoenix, AZ.