1	Leading Cause of Death Youth 12 to 24 year old Leading Cause Death (2003) Motor Vehicles – 126 Suicide – 62 Cancer – 27 Homicide - 24
2	Suicide & Mental Health (Children 11 to 17 yrs old) 1 out of 5 have a mental disorder 1 out of 10 are severally impaired 4 out of 5 are never identified 1 out of 2 gay children will attempt suicide There are resources to help 1 out of 10 children in need. 1 out of 16 will attempt suicide 1 out of 10 who attempt will go to an ER
3	Suicide (Deschutes County) Completed Suicide Attempts 15 to 19 yrs old – (waiting for this from the State) 20 to 24 yrs old - (waiting for this from the State)
4	Suicide Mechanism (2003) Firearms = 43% Suffocation = 39% Completed Attempts 15 to 19 yrs old - (waiting for this from the State) 20 to 24 yrs old - (waiting for this from the State)
5	Precipitating events ERs, 2003 Family discord 57% School-related problem 31% Argument with boy/girlfriend 20% Substance abuse 17% Rape or sexual abuse 11%
6	Precipitating events ERs, 2003 Peer pressure/conflict 8% Move or new school 5% Physical abuse 5% Death of family member/friend 5% Problems with the law 4% Suicide by friend/relative 2% Pregnancy 1% Other 40%
7	Who did youth tell prior to a suicide attempt Parents – 45% Friends – 32% Siblings – 8% Counselors – 3% Teachers – 2%
8	Who did youth tell prior to a suicide attempt.
9	Poor vs. Affluent Nationally Affluent children appear to have higher rates of Depression Alcohol and other drug use Suicidal behavior Reason affluent youth are high risk They have money but don’t earn it Not supervised High expectations to be successful and no excuses Culture of endless pursuit of pleasure and stimulation
10	Suicide Attempts that go to a Hospital ER Deschutes County ER visits = 42 are seen in ER. (but we believe it is probably 2xs that) Attempt Rate = 258.3 per 100,000 Males = 4 Females = 38 Less than 12 yrs = 3 13 to 15 yrs old = 13 15 to 17 yrs old = 26
11	Suicide Attempts that require medical attention Nationally = 1 out of 16 (5% to 19%) In Bend LaPine School District Estimated to be 485 per year
12	Children who Seriously consider Suicide Deschutes, Oregon Healthy Teen survey (2003) 8^th grade girls = nearly 20% 8^th grade boys = nearly 7% 11^th grade girls = 15% 11^th grade boys = nearly 9%
13	Issues We CANNOT screen effectively for the risk of completing suicide. We CAN screen for the risk of suicidal behavior Preventing suicidal behavior should focus more on parents and children, not just teachers and school counselors. Children who attempt once are at greatest risk for a second attempt
14	Issues Prescriptions for psychiatric Meds are increasing Referrals for psychotherapy are decreasing. Antidepressants double the risk of suicidal acts. Antidepressants are often prescribed to Bipolar manic children because they present as depressed and anxious. This substantially increases the risk of violence and suicide. International consensus: Psychotherapy is a “first line” intervention or should be used with Antidepressants.
15	Issues In clinical trials, no antidepressant appears to be significantly more effective than another. The primary difference between antidepressants is the severity of side effects. This means that there is a very small chance for improvement by changing or taking more than one antidepressant.
16	Bend Study Mentor Research Institute, 2005-2006 Antidepressants do not sufficiently improve the behavior of children. Many children who are taking antidepressants are still delinquent, oppositional, defiant, aggressive, suicidal, violent, failing school, skipping school, promiscuous, or using drugs and alcohol. Nearly all of the children surveyed who were on more than one medication, or had multiple trials, had significant behavioral problems, and were significantly depressed and anxious.
17	An Important Question Are antidepressant medications productive if they reduce some symptoms but do not restore the ability to function adequately or successfully?
18	Bend Study The results suggest that professionals and communities should re-examine their expectations if they are assuming psychiatric medications are tools that provide social control and insure community safety. The survey results suggests that behavioral health, and parenting skills, as well as individual and family therapy, are important for adolescents when antidepressants or more that one medication is prescribed. The results of this survey suggest that medications alone are not sufficient.
19	Suicide Prevention Program School Jason curriculum-ASSIST/QPR for school staff-school counselor awareness and participation Public Health Connecting Youth - a public health based intervention County Mental Health Crisis Line and Crisis Services Community-Based StepOne for Parents State Mental health ASSIST/QPR
20	Strengths Deschutes County
21	Weakness Deschutes County Access to care Uninsured Not enough therapists who do family work Extremely poor access in outlying areas (La Pine) Decrease in school mental health resources (FAN cuts)
22	Controversy Deschutes County School based screening and intervention Emphasis on medications “Fragmented services” verses “No services” Non-evidence based practices
23	Percentage of self-reported risk behavior among 8^th graders by gender, Oregon, 2003
24	Percentage of self-reported risk behavior among 11^th graders by gender, Oregon, 2003