Tennessee Department of Mental Health and Substance Abuse Services

The Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) proposes Tennessee TARGET Zero Suicide 2 (TARGET2) to reduce suicide attempts/deaths among adults ages 25 and older by expanding and enhancing suicide prevention strategies, including rapid and enhanced follow-up for 2,750 unduplicated target region adults (Yr 1: 750; Yrs 2-3: 1,000/yr) and prevention training for 300 statewide providers and stakeholders. The statewide focus population ages 25 and older is primarily white (78%), with 15% African American and 2% Hispanic/Latino. Over 13% live below poverty, 14% lack health insurance, 15% lack a high school diploma, and over 7% are unemployed. Focus population clinical characteristics (e.g., SMI, SUD, COD) are risk factors for suicide attempt/death. The focus population’s suicide rate (20.9) exceeds the U.S. rate (18), and has consistently exceeded the national rate for 15+ years. Baseline data for Tennessee reveals that 937 adults ages 25 and older died by suicide, and 6,275 were discharged (inpatient, outpatient) after non-fatal suicide attempts in 2015. The adult (25+) suicide rate among Tennessee’s minority groups other than African Americans is 11.6 versus an 8.8 national rate, and Veterans comprise 17% of state suicides.

TDMHSAS will implement the following strategies/interventions throughout TARGET2 in collaboration with project partners: Centerstone of Tennessee will provide rapid enrollment and follow-up prior to/within 24 hours of discharge and weekly for one month. Follow-up will include risk assessment, crisis management plan development, means reduction counseling, and referrals/linkages to treatment services utilizing best practices Applied Suicide Intervention Skills Training, Counseling on Access to Lethal Means, and evidence-based Columbia Suicide Severity Rating Scale. TARGET2 participants will be assessed and treated according to Centerstone’s Clinical Pathway for Suicide Prevention, and Centerstone will pilot and evaluate a suicide-specific clinical treatment for those on the Pathway. The Tennessee Suicide Prevention Network will provide suicide prevention trainings for clinical providers and adult-serving systems, and will assist in establishing/implementing a Gatekeeper Surveillance Network and Call Line for training participants. TARGET2 will expand the Zero Suicide framework statewide, and an existing Advisory Council, comprising suicide attempt/loss survivors, will support TARGET2’s goals, including:

(1) enhance/expand rapid follow up for adults post discharge,
(2) increase follow up and care transition/coordination for high risk adults,
(3) train community and clinical service providers and systems,
(4) collaborate with relevant sectors and with state departments/ systems to implement comprehensive suicide prevention, and
(5) implement Goals 8 and 9 of the 2012 National Suicide Prevention Strategy.

Measurable objectives include reductions in suicide attempts by 35%, suicide deaths by 20%, and service/utilization costs related to suicide by 30%. TARGET2 includes a comprehensive evaluation to develop and disseminate a thoroughly documented service model for replication and adoption.