First, we have very good news to report. The Department of Public Health was one of eight in the country to receive a grant from the Centers for Disease Control to hire a staff person to develop infrastructure for responding to youth violence both self-directed (suicide and attempts) and interpersonal. At the same time the Columbia University Depression Teenscreen program chose Iowa as one of five states in which to implement its program. Several school districts and AEAs have agreed to participate in this program that requires a minimum of 200 students and immediate (24 hour) access to mental health services as a prerequisite for implementation. Where it has been used, a certain percentage of students have been referred for help.

In 2004 Rep. Vicki Lensing (D-Iowa City) and Sen. Amanda Ragan (D-Mason City) and Sen. Maggie Tinsman (R-Davenport) drafted suicide awareness resolutions respectively for the Iowa House (HR 162) and Senate (SR 151). These resolutions identified suicide as a “serious problem affecting the entire state” and recognized that “a variety of suicide prevention programs are needed for all populations and in all communities of the state.” While the resolutions were not voted on, they laid the basis for a bill that the Legislative Service Bureau is drafting this year to establish an Office of Suicide Prevention in the Department of Public Health. We hope that there is a good discussion about this bill during this legislative season, and approval of funds to staff it and provide money for programs.

However, given the financial condition of the state, we are not holding our collective breath! Rather, we are working on an action-oriented state plan to address lifespan concerns regarding suicide. This state plan will give people in all state departments as well as private agencies the foundation from which to seek federal or private funds for suicide prevention.

The plan begins with a statement that suicide is a public health issue which calls us to take five steps: 1) clearly define the problem; 2) identify risk and protective factors; 3) develop and test interventions; 4) implement interventions; and 5) evaluate effectiveness.

The problem is that there has been an average of 304 suicides in Iowa over the years 1998-2002, with 350 suicides in 2003, the last year for which statistics are available. The deaths range from age 9 to 90, and occur in every region of the state. Among those 15-24 years old, suicide is the second leading cause of death in Iowa.

Protective factors largely include access to mental health services, strong family and community support, ability to solve interpersonal problems and disputes, and restricted access to lethal means. Risk factors can be biophysical, such as a history of trauma and abuse, impulsiveness and aggressiveness, and previous suicide attempts. They can be environmental, such as a job loss or social loss, or socio-cultural, such as stigma associated with seeking help or religious beliefs that condone suicide. When we consider the economic downturn in much of the state in 2003 both for individuals and for state support of social services, it seems probable that the increase in suicide is related. When we consider the loss of population in most counties of Iowa, and the resultant increasing isolation of those remaining, it seems likely that the increase in suicide is related.

We propose eight goals to strengthen suicide prevention in Iowa.

1. A public awareness campaign to increase the number of people seeking services.
2. Develop evidence-based prevention programs in institutional settings, such as schools and colleges, correctional institutions, and professional organizations.
3. Restrict access to lethal means, such as promoting safe storage of guns, reducing the gasses in exhaust fumes, or installing railings at high places.
4. Training programs to recognize the signs of suicide, especially for those who are first responders to scenes of crisis.
5. Promoting clinical and professional development, such as including suicide prevention in recertification programs and developing suicide survivor programs for first responders and other professionals who come into contact with suicide attempts and completions in their work.
6. Support for mental health and substance abuse treatment, such as advocating a bill to establish mental health parity in insurance coverage.
7. Monitor media reports of suicide to reduce likelihood of copycat suicides.
8. Carry out surveillance, which means supporting good data collection processes and annually updating the analysis of suicide data to track changes among age groups, between the sexes, and in the regions of the state with the aim of publishing annually a report on the Iowa Face of Suicide, and informing prevention efforts.

At the same time the committee rewriting the Healthy Iowan 2010 goals have developed six action steps. These are:

12-2.1 Action Step
In collaboration with schools and community agencies, regularly disseminate suicide awareness materials to community members. (Iowa Department of Public Health Action Step.)

12-2.2 Action Step
Increase public awareness of suicide risk factors and prevention strategies by preparing a list of books and other resources on these topics for public, private, and school libraries by 2010. (An Iowa Department of Public Health Action Step.)

12-2.3 Action Step
Continue to work with television, radio, and newspaper media to regularly inform the public about the risk factors associated with suicide. (An Iowa Department of Public Health Action Step.)

12-2.4 Action Step
By 2010, conduct education and awareness forums for the geographic areas having the highest incidence of suicide during the most recent years for which IDPH data are available. (An Iowa Department of Public Health Action Step.)

12-2.5 Action Step
Strengthen the state’s resources for preventing suicide by increasing the number of those qualified to train service providers on suicide intervention topics, including education and mental health. (An Iowa Department of Public Health action step.)

12-2.6 Action Step
Identify a program to train employers to recognize signs of suicide in young adults, especially in males outside higher educational systems. Identify a model employee assistance program to meet the needs of young adults. (An Iowa Department of Public Health Action Step.)

The Suicide Prevention Strategy steering committee will be meeting in late May to integrate the plan and these steps, and to finalize and approve a comprehensive plan. We would welcome comments and suggestions about the plan or the action steps listed above.