Partnering in Flint to Research Suicide Prevention and Reduction

Jennifer E. Johnson, C.S. Mott Endowed Professor of Public Health in the MSU College of Human Medicine

In 2015, more than 41,000 people committed suicide in the United States, according to the Centers for Disease Control and Prevention. Suicide is the second leading cause of death for Americans between the ages of 15 and 34. While one of the main predictors of suicidal behavior is the presence of major depression, stressors play a role.

Jennifer Johnson is a clinical psychologist and principal investigator on a four-year, $6.8 million project awarded to MSU by the National Institute for Mental Health (NIMH), National Institute of Justice, and National Institutes of Health's Office of Behavioral and Social Science Research to study effective suicide prevention strategies for recently-released pretrial jail detainees. The Suicide Prevention Intervention for at-Risk Individuals in Transition (SPIRIT) Trial, will follow 800 recently released pretrial detainees from the Genesee County Jail in Flint, Michigan, and the Department of Corrections in Cranston, Rhode Island.

According to research by Johnson and Lauren Weinstock of Brown University, published by NIMH, "10 percent of all those who die by suicide are estimated to have had some type of recent criminal legal stressor (often an arrest and jail detention)."^[1]

The criminal justice system has become a catchment area for many people who struggle with mental health issues. For example, the three largest mental health treatment facilities in the country are jails—Cook County (Illinois), Los Angeles County (California), and Rikers Island (New York). With nearly 12 million people passing through jails each year in the United States, the country's county jails are a place where suicide prevention strategies can potentially be implemented to good effect.

Johnson came from Brown University in January of 2015 to serve as C. S. Mott Endowed Professor of Public Health at MSU's new College of Human Medicine campus in Flint. According to Johnson, who is experienced with intervention and the criminal justice system, a standard of care for individuals in pretrial detainment who are at risk for suicide simply doesn't exist. "You have a system that picks up a lot of at-risk folks—people with mental illness, people with bipolar schizophrenia, addiction, etcetera," she said, "but then just lets them go with very little or no follow-up due to lack of resources."

A couple years ago, the NIMH approached researchers in Johnson's previous department of psychiatry and human behavior at Brown University. NIMH had realized that almost half of individuals who complete suicide were not in mental health treatment, and that many had contact with the criminal justice system. Lauren Weinstock, another associate professor of psychiatry and human behavior at Brown University and psychologist at Butler Hospital and the study's other principal investigator, discussed the issue with Johnson. Together they developed the trial, the basis of which is evaluating the effectiveness and cost-effectiveness of Stanley and Brown's Safety Planning Intervention, which has proven to be very effective in hospital emergency departments.

Better Care for a Vulnerable Population

Johnson explains that in many ways a county lock-up is similar to an emergency room. Both receive many at-risk people at a high acuity moment and then release them back out into the world. The safety plan that has been developed is simply explained. Before patients—or in the case of the SPIRIT Trial, detainees—leave the facility, they have a short interview with a mental health professional.

Johnson said, "A mental health professional will sit with somebody and ask a series of questions, like: What are your triggers when you're feeling suicidal? What kind of internal coping strategies could you use? How could you distract yourself? Where can you go to distract yourself that's social? Who can you tell if you're really in trouble? Do you have access to firearms, pills? Do you need to give those to a friend for a while? What services do you need?"

To run the trial, Johnson and Weinstock rely on a number of partners, including jail officials and community mental health professionals. For example, Johnson explained, "We're bringing in counselors from the community mental health centers, since these are the places people would most likely go to seek help after release. The counselors come and meet with those at-risk in the jail once, help provide linkage to community resources, and then follow up by phone afterward to address any problems that arise."

Here in Michigan, the trial will rely on counselors from Genesee Health System (GHS) in Flint. Dan Russell is the CEO of GHS. "We are very excited and proud to be a part of Dr. Johnson's ground breaking research," he said. "Our staff that will be involved will have an incredible opportunity to participate in one of its kind research, and help a very underserved and neglected population." Additionally, according to Russell, those professionals who are participating will gain skills and experience that are not usually available to clinicians in public mental health organizations.

The potential impact of the study, however, goes beyond the experience his clinicians will gain. The community as a whole is expected to benefit. "As an organization, we get to be part of a major research initiative that has the potential to add new knowledge to the field," Russell said. "The community will benefit in many ways, in terms of better care for vulnerable residents, and an increase in reputation that will help for the future, not to mention the positive economic impact of the research."

When discussing her move to Flint, Johnson was quick to point to Flint community partners as the motivating factor. "I would say that this trial is community-partnered, but the other Flint researchers and I have projects in Flint that are community-driven, meaning that the impetus for the projects arises from requests of community members," she said. "I am partnered with the professional community, who are fantastic, and we also have journal articles and grants written and conducted in full and equal partnership with grassroots community members. Community Based Organization Partners (CBOP) and other primarily African-American community organizations based here are incredible."

The SPIRIT Trial is just one of the research initiatives Johnson anticipates working on here in Flint. When the trial concludes, she and her colleagues will know if they have identified an impactful tool for addressing population-level suicide prevention and reduction. As she said, "If these interventions are as effective in pretrial jail detention as they are in emergency rooms, we could reduce U.S. suicide rates by 5 to 10 percent."

Sources

1. Johnson, J., & Weinstock, L. (2015, September 21). Embracing the SPIRIT of reducing suicide. Science Update. Retrieved from http://www.nimh.nih.gov/news/science-news/2015/embracing-the-spirit-of-reducing-suicide.shtml.Return to text