DNP 711 - Week 13:

INTRODUCTION/OVERVIEW: The Implications for Healthcare Financing & Sustainable Innovation Strategies of Suicide Prevention

From the 2020 Suicide Prevention Action Plan, in Arizona, the past ten years is continuing to reveal a dark trend arising in both the total number and frequency in suicide rates (ADHS, 2020). For both 2017 and 2018, suicide was the 8th leading cause of deaths among Arizona residents (ADHS, 2020). Depression and suicide as a significant public health crisis account for more than 40,000 deaths in the U.S. annually (Bridge et al., 2014; CDC, 2017a). In 2015, on average, there were 129 suicides per day, and self-injury/suicide cost the U.S. $69 billion (AFSP, 2019b). The estimated average cost per suicide death is more than $1.3 million (Shepard et al., 2016). Despite the immediate impacts that loss of life by suicide incurs, high emotional and economic costs also compound, resulting in about $44.6 billion annually in combined medical and work loss costs in the U.S. alone (Twenge et al., 2018). Most of the total costs associated with suicide deaths result from the lost productivity of individuals (97 percent) compared to the minimal costs associated with medical treatment (3 percent)(Shepard et al., 2016). In 2017, suicide attempts reached an estimated 1,400,000 people (AFSP, 2109b). In 2013, the total cost valuation estimates of suicide and suicide attempts were $93.5 billion, which is indicative that for every $1.00 spent on psychotherapeutic interventions and prevention efforts saved $2.50 in the costs attributable to suicide deaths (Chisholm et al., 2016; Shepard et al., 2016). Even using the most conservative estimates, the potential benefits that result from interventions such as general suicide education and peer support programs total at least $22 million per year (Sari et al., 2008).

Suicide ranks as the second leading cause of death among people ages 10-34 and a significant global public health crisis.3,6 Suicide rates increased by 24% within the past 15 years (CDC, 2017b). The time spent by adolescents and emerging adults in the past decade doubled (Ofcom, 2017; Orben & Przybylski, 2019). Adolescent mental health issues continue to rise sharply, especially among females (Twenge et al., 2018). Dependence on our mobile devices and social media use may increase our current mental health crises, especially among emerging adults and adolescents. Understanding how digital technological advances influence the mental health of young adults could impact our abilities of suicide prevention and self-harm reduction efforts.

The activation of any advocacy plan requires creative and innovative uses of environmental resources, and in many instances, also includes engaged participation in professional and specialty associations (Patton, 2014). Whereas, policy implementation involves another set of common elements such as goal refinement, influential application, strategic issue framing, and audience targeting to ensure that communication efforts are successful in their delivery of information (Patton, 2014). Specific to the sustainability issues of suicide prevention efforts, another element critical to advocacy planning is resource assessment to evaluate what is currently available or need future procurement before policy implementation begins, which often includes human resources analyses, data resources, economic projections, and communication capabilities evaluation (Patton, 2014).

Many private entities and public sector institutions are working to improve suicide awareness and prevention efforts. However, the resilience capacity and sustainability of these groups is dependent on financial resource management and fundraising capabilities. The American Foundation for Suicide Prevention (AFSP), as the largest private-sector organization, spent more than 37 million dollars in 2019 on operational costs associated with suicide awareness and prevention (AFSP, 2019a). The AFSP is an example of an organization that provides extensive human resources and financial capital investment into the “research, education, and advocacy actions against this leading cause of death” (AFSP, 2020). The AFSP mission statement presents that they are “dedicated to saving lives and helping those affected by suicide" (AFSP, 2020). Organizationally, much of the AFSP's work focuses on fostering and building "a culture of mental health awareness by funding scientific research, educating the public about mental health and suicide prevention, advocating for public policies in mental health and suicide prevention, and supporting survivors of suicide loss and those affected by suicide in our mission” (AFSP, 2020).

Many other private sector organizations (e.g., AAS, NAASP, ICRC-S, SAVE), like the ones highlighted in previous blog posts, raise and spend substantial amounts of financial capital annually (AAS, 2020; NAASP, 2020; ICRC-S, 2020; SAVE, 2020). However, the public sector institutions outspend and assume most of the annual financial burden associated with suicide prevention efforts. Some of the public sector institutions contributing to the efforts of suicide prevention in the United States are the National Institutes of Health (NIH) through its subsidiary of the Substance Abuse and Mental Health Services Administration (SAMHSA). Of the various contributing public organizations, the most significant source of financial support comes from the federal government. For example, trends in recent spending suggest that SAMHSA expends approximately $50 million each year on suicide prevention where the funneling of the majority of these funds are towards the disbursement of grants, maintenance of the suicide prevention hotline, and funding for Zero Suicide programs (SAMHSA, 2018). Another example of a public sector institution that contributes to much of the programmatic spending related to suicide prevention efforts is the National Institute of Mental Health (NIMH), another division of the NIH, which is accountable for oversight of evaluating and selecting studies to be funded (NIMH, 2019). Many lines of current funded-research often focus on prevention techniques and improved methods for identifying at-risk individuals (NIMH, 2019). In contrast, others concentrate on the best methods for encouraging health professionals to utilize the validated and reliable methods previously developed for the identification or treatment of at-risk individuals (NIMH, 2019).

While policymaking advancements do not occur instantaneously or within a political or social vacuum, it is an iterative process that becomes evolutionary and adaptive because of an accumulation of collaborative engagement between various policymaking actors and agents. From the executive or legislative realms to the public or private sector partnerships, Longest (2014) argues that, within foundationally complex domains, such as healthcare services delivery, a bias exists for incrementalism, iterative adjustment, or continuous modification in policy scaling and execution. Essentially, what Longest (2014) is re-presenting is the idea of "kaizen" or continual improvement, which has been a core ideal of product manufacturing for decades (Sutherland, 2014). One of the distinct benefits of such procedural iteration is the overall gain or potential maximization of resilience for both organizations and policymaking efforts. The relationship between sustainability and resilience is that they both seek to improve long-term prospects; sustainability by making choices that lessen the burdens born by the environment, and resilience by developing the capacity to make timely changes before cost expenditures become prohibitive (Valikangas, 2010). Many of the policy proposals and policymaking efforts within Arizona and outlined throughout this blogging project, specifically regarding suicide prevention and self-harm reduction measures for young and emerging adults, focus on this iterative approach, which allows for the underlying "economic and social systems to adjust [adequately] without being unduly threatened by change" (Longest, 2014).

References:

American Association of Suicidology. (2020). About AAS. Retrieved from https://suicidology.org/about-aas/

American Foundation for Suicide Prevention. (2019a). American foundation for suicide prevention financial report. Retrieved from https://www.datocms-assets.com/12810/1577067401-american-foundation-for-suicide-prevention-6-30-19-final-1.pdf

American Foundation for Suicide Prevention (AFSP). (2019b). Suicide statistics: U.S. 2019. Retrieved from https://afsp.org/about-suicide/suicide-statistics/

American Foundation for Suicide Prevention. (2020). About AFSP: Mission. Retrieved from https://afsp.org/about-afsp/

Arizona Department of Health Services (ADHS). (2020). Suicide prevention action plan.

Bridge, J. A., Horowitz, L. M., Fontanella, C. A., Grupp-Phelan, J., & Campo, J. V. (2014). Prioritizing research to reduce youth suicide and suicidal behavior. American journal of preventive medicine, 47(3), S229-S234.

Centers for Disease Control and Prevention (CDC) Data and Statistics. Fatal Injury Report for 2017 [online]. (2017a) [cited 2020 Apr 19]. Available from URL: https://webappa.cdc.gov/sasweb/ncipc/mortrate.html

Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. (2017b) [cited 2020 Apr 19]. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. Available from URL: www.cdc.gov/injury/wisqars

Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-up treatment of depression and anxiety: a global return on investment analysis. The Lancet Psychiatry, 3(5), 415-424.

Injury Control Research Center for Suicide Prevention. (2020). Who we are. Retrieved from http://suicideprevention-icrc-s.org/who-we-are

Longest, B. (2014). Health policymaking in the United States (6th ed.). Chicago, IL: Health Administration Press.

National Action Alliance for Suicide Prevention. (2020). About us: Our story. Retrieved from https://theactionalliance.org/about-us/our-story

National Institute of Mental Health. (2019, July). Suicide Prevention. https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml#part_153180

Ofcom. (2017). Children and Parents: Media Use and Attitudes Report. Retrieved from https://www.ofcom.org.uk/research-and-data/media-literacy-research/childrens/children-parents-2017

Orben, A., & Przybylski, A. K. (2019). The association between adolescent well-being and digital technology use. Nature Human Behaviour, 3(2), 173.

Patton, R., Zalon, M, & Ludwick, R. (2014). Nurses making policy from bedside to boardroom. New York: Springer publishing company.

Sari, N., de Castro, S., Newman, F. L., & Mills, G. (2008). Should we invest in suicide prevention programs?. The Journal of Socio-Economics, 37(1), 262-275.

Substance Abuse and Mental Health Services Administration. (2018, September 21). SAMHSA awards $61.1 million in suicide prevention funding. Retrieved from https://www.samhsa.gov/newsroom/press-announcements/201809211000

Shepard, D. S., Gurewich, D., Lwin, A. K., Reed Jr, G. A., & Silverman, M. M. (2016). Suicide and suicidal attempts in the United States: costs and policy implications. Suicide and Life‐Threatening Behavior, 46(3), 352-362. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/sltb.12225

Suicide Awareness Voices of Education. (2020). Who we are. Retrieved from https://save.org/who-we-are/

Sutherland, J. (2014). Scrum: The Art of Doing Twice the Work in Half the Time. New York: Crown Business/Random House.

Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among U.S. adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 6(1), 3-17.

Välikangas, L. (2010). The resilient organization: How adaptive cultures thrive even when strategy fails. New York: McGraw Hill Companies, Inc.