Thursday, April 25, 2013

Health Care Reform: The Opportunity for Suicide Prevention

By Michael Hogan, Ph.D., Independent Advisor and Consultant at Hogan Health Solutions LLC, Action Alliance Executive Committee member, and co-lead of the Clinical Care and Intervention Task Force When the Action Alliance selected the integration of suicide prevention into health care reform as one of its four national priorities stemming from the National Strategy for Suicide Prevention, it was still unclear as to what the Supreme Court’s response would be to legal challenges involving the Affordable Care Act. Either way, the Action Alliance felt that major changes to the health care system were going to occur. Should we not strive to use the momentum of reform to better focus health care on people at risk for suicide? Most mental health professionals and advocates agree that the health and behavioral health care system in the US does not currently meet the needs of patients struggling with suicidal behavior – in sum, “suicide care” is inadequate. Health care reform presents the most significant opportunity in a generation to make the health care system more responsive to individuals who are at risk for suicide or who are engaging in suicidal behavior. It’s an opportunity to save lives, contributing to the realization of the Action Alliance’s goal of saving 20,000 lives in five years. The US Centers for Medicare and Medicaid Services (CMS) has the lead responsibility of interpreting and implementing the Affordable Care Act of 2010, and the Substance Abuse and Mental Health Services Administration (SAMHSA) has the lead on behavioral health issues. For this reason, the Action Alliance has been working with SAMHSA Administrator Pam Hyde to engage senior CMS leadership in a conversation about the integration of suicide prevention into health care reform over the last year and a half. Health care reform aims to deliver what former CMS Administrator Don Berwick called the Triple Aim: better health for populations, better care for individuals, and reduced costs to society. Transforming health systems to prevent suicide and improve suicide care addresses all of these goals. By identifying patients at risk for suicide early, risks can be reduced and effective treatment can be delivered. By providing early and effective treatment in a behavioral health setting or in a collaborative care setting where primary care and behavioral health care are integrated, we can save lives and prevent some suicide attempts that result in costly emergency medical expenses. We know that people admitted to hospital or emergency department care with suicidal behavior remain at high risk when they leave. And we know that if we ensure a patient receives continuity of care through the discharge and out-patient care engagement process, we can reduce expensive re-hospitalizations and suicides. We have also learned that when health systems focus on safety and suicide care, the results are far better than those achieved through piecemeal approaches. One of the keys must be leadership among health plans and systems. They can encourage better screening for depression and suicidality, delivery of effective, evidence-based treatment and continuous care to patients who are at risk. Health plans and payers must transition from paying for the quantity of episodic services to paying for better integrated care that will change the health outcomes of populations. I have been privileged to meet with the Action Alliance Co-Chairs, SAMHSA Administrator Hyde, CMS Administrators (Acting Administrator Don Berwick in 2011, and current Acting Administrator Marilyn Tavenner in 2012), my fellow Action Alliance Executive Committee member Paul Schyve, and the Action Alliance Secretariat on several occasions to discuss areas of health care reform implementation that are relevant and critical to suicide prevention. The Action Alliance has also submitted public comments in response to CMS’s efforts to implement electronic health record technology. In all of our interactions, we have focused on three domains: promoting early identification of those at risk for suicide, the delivery of effective treatment for suicidal behavior, and the provision of the follow-up care for those at risk as they transition from one setting of care to another. Later this year, the Suicide Prevention Resource Center will partner with The National Council for Community Behavioral Healthcare to “go live” with a website providing tools for providers to take these steps. These improvements within an evolving health system are the key targets for getting us to that goal of saving 20,000 lives in five years. What do you think? How would you like to see suicide prevention integrated into health care reform? Please comment and share your ideas below.

Tuesday, April 23, 2013

No Known Benefits Of Suicide Screening In Primary Care Settings

Banner No Known Benefits Of Suicide Screening In Primary Care Settings By News Staff | April 22nd 2013 09:08 PM | 1 comment | Print | E-mail | Track Comments News Articles More Articles Bacterial Vaginosis - More Common Than Yeast Infections And A Risk For Premature Births, STDs Water, By Jove: Shoemaker-Levy 9 Impact Still Evident Today In Jupiter's Atmosphere Phase IIb Aviator Trial Shows High Viral Response Rates In Patient Types With HCV Genotype 1 All Articles About News News From All Over The World, Right To You... View News's Profile User pic. News Staff Suicide is the 10th leading cause of death in the United States. Statistics show that 38 percent of suicidal adults and 90 percent of youths had visited their primary care physicians in the 12 months prior to committing suicide. An evidence review finds that while there are screening tools to help physicians identify adults at risk for suicide, there's no evidence that using these screening tools in primary care will actually prevent suicides. In adolescents, there are no proven primary care-relevant screening tools to identify suicide risk. The U.S. Preventive Services Task Force reviewed evidence for upcoming recommendations on suicide screening and treatment for adults and adolescents and issued a paper. Finding accurate and feasible screening tools that can be used in the primary care setting could help to identify those at increased risk for suicide so that appropriate preventive measures can be taken. In 2004, the U.S. Preventive Services Task Force (USPSTF) concluded that evidence was insufficient to recommend for or against routine screening by primary care clinicians to detect suicide risk in the general population. To update its previous recommendation, the Task Force reviewed 56 studies published between January 2002 and July 2012. Although evidence was limited, the researchers found that primary care-feasible screening tools could probably identify adults at increased risk for suicide who need treatment. However, screening tools have limited ability to detect suicide risk in adolescents. Treatment with psychotherapy reduced the risk for suicide attempts by 32 percent in high-risk adults (e.g., those with a recent suicide attempt), but did not appear to benefit adolescents. No drug treatments were proven effective at reducing suicide risk in adults or adolescents. Here is the draft recommendation statement based on this evidence review

Demographics of Homicide and Suicide Victims Reveal Differences

City Room - Blogging From the Five Boroughs New York by the Numbers April 23, 2013, 9:51 am Comment Demographics of Homicide and Suicide Victims Reveal Differences By SAM ROBERTS More people killed themselves last year in New York City than were murdered, the authorities have said, a consequence of the city’s plunging murder rate. A peek behind the numbers reveals some interesting differences. New York by the Numbers Mining public data. While men died in disproportionate numbers from both causes, the victims of homicide and suicide come from very different universes. Typically, most murder victims are young and black. Most suicides are older and non-Hispanic white. “There’s no explanations that I think are fully satisfying and explain what accounts for the contrast,” said Dr. Sandro Galea, an epidemiologist at Columbia University’s Mailman School of Public Health. “What you’re seeing is a reflection of the context in which homicides and violence are endemic,” he said. “The myth of the unexpected homicide occurring to a wealthy person in a wealthy neighborhood is vanishingly rare.” “The vast majority of suicides are known to have had some psychopathology, and although the literature is muddy, depression is more common in majority groups,” Dr. Galea continued. “The second reason may well be that there are different coping mechanisms among minorities that are more externalism than internalizing. But there’s an interesting paradox: If we know that adverse living circumstances are associated with greater risk of depression why aren’t minorities more prone to suicide?” According to preliminary figures from the Police Department, 418 murders were recorded in 2012. Among the victims, 84 percent were men, 60 percent were black, 27 percent were Hispanic, and 9 percent were non-Hispanic white. (Among the known assailants, 93 percent were men; 53 percent were black and 35 percent were Hispanic). More than two-thirds of the victims were 40 or younger. In 2011, the city’s health department recorded 509 suicides. Though the rate for 2012 is not yet available, city officials believe that, based on recent trends, suicides outnumbered murders last year. While the homicide rate has been declining, the suicide rate has remained fairly steady in the last decade. Homicide was the leading cause of death among New Yorkers 15 to 34, suicide was third among 15- to 24-year-olds and fourth among 25- to 34-year-olds. Among people under 65, suicide was the third leading cause of death among Asians, fifth among non-Hispanic whites and non-Puerto Rican Hispanic people. It was not among the top 10 causes of death among blacks. Non-Hispanic whites recorded the highest death rates from suicide, blacks the lowest. Louis B. Schlesinger, a professor of forensic psychology at John Jay College of Criminal Justice, said the shifting ratio of murders to suicides reflect two other factors: “A lot of suicides go unreported,” he said, “and because of the increased sophistication of emergency medical technology, people who 10 years ago would be dead from murder are now living.”

Friday, April 19, 2013

Welcome to Crime Victim Services

This blog site is to designed to be both informative and entertaining as a source for crime victim services as well as crime stories and crime scene cleaning topics. Other topics will be added that are relevant in some form or matter to the above headings.

Specific topics are;
Suicide, Homicides, Crime Scenes, etc

Cleaning -how to, and informative aspects of different ways to clean stuff!

Crime stories both good and bad.

Victim Services - Victims of crime and tragedy

Feel free to post comments appropriate for the subject matter.

Marc Onesta
Bio Scene Clean Up

Florida Apartment Shooting Generates Questions of Landlord Liability

Florida Apartment Shooting Generates Questions of Landlord Liability

February 21, 2013
Recently in Florida, three people were shot while walking in an apartment's public space by an unknown number of suspects. Two of three died from their injuries and one remained wounded. The apartment is in a gated residence. Crime in apartment complexes or other public spaces are common, and accountability and relief does not just come from the perpetrator of the crime, but from the owner of the premises.
A landlord can be held liable for a crime that occurs on his or her property by a third party if the crime is considered foreseeable and if the crime would have been considered preventable, had the owner put certain precautions in place. Much of the liability hinges on the relationship of the owner to the person injured on the property. If the injured party was a tenant or a guest of the tenant, or someone else invited onto the property by the owner, then the landlord has a duty to maintain a reasonably safe condition. They must also warn of any dangers that these same parties may not know themselves. However, if the people on the property were not invited, then the landlord does not have a duty to guard against third party crimes.
apartments.jpgFlorida courts have considered what is foreseeable. If other prior crimes of a similar nature have occurred on the premises, then that type of crime is considered foreseeable. (See Prieto v. Miami-Dade County, 803 So. 2d 780 (Fla. 3d D.C.A. 2001)). Also, if the area is a "high crime" area, where similar crimes occurred in temporal and geographic proximity to the apartment, then liability for a crime on the premises could be created.
Some Florida courts have extended beyond similar crimes or crimes that have occurred in a specific geographic proximity. The Fourth District Court of Appeals has allowed evidence of dissimilar crimes and the Third District allowed evidence of crimes in an area outside of the premises so long as they weren't 'substantial distances away'. (See Holiday Inns, Inc. v. Shelburne, 576 So. 2d 322, 331 (Fla. 4th D.C.A. 1991) and Lomillo v. Howard Johnsons Co., 471 So. 2d 1296, 1297 (Fla. 3d DCA 1985).)
Landlords are liable for accidents and injuries beyond criminal acts that occur on the premises. If an accident occurs because of damaged property or negligently maintained structures, then the landlord is also liable to any occupant or other invited guest. A landlord must maintain safe and healthy premises, and should not leave common spaces in disrepair. Poorly lit hallways or slippery stairs may contribute to a fall which can lead to expensive medical care.

If you have been injured while on the premises of a rental property or other public building the South Florida premises liability attorneys at Friedman, Rodman & Frank have the experience it takes for you to find the compensation you need for medical bills and compensation for other pain and suffering. Our South Florida offices are located in three convenient locations for you. If you would like a free, confidential conversation contact us online or call (877) 448-8585.