The Center for Disease Control (CDC) developed the Youth Risk Behavior Surveillance System (YRBSS) to monitor high-risk behaviors among teens and young adults. One of the behaviors monitored are suicides. The Center for Drug and Health Studies (CDHS) at the University of Delaware conducts Delaware’s Youth Risk Behavior Survey (YRBS). It administers the Youth Risk Behavior Survey to middle school and high school students across the state.
Statistics: Delaware High School Students in 2015
14% considered suicide in the prior 12 months – 4 students in a class of 28
11% made a plan in the prior 12 months.
7.6% attempted suicide in the prior 12 months – this represents about 3000 students a year
2.3% attempted suicide and received medical care as a result.
Although Delaware is below the national average in each of these categories, this should be of little comfort since thousands of lives are at risk.
What This Means:
The two last numbers above, 7.6% and 2.3%, show that many more students attempt suicide but only a relatively small number 2.3% seek medical assistance. This means that most suicidal students do not get help since nobody knows about the attempt! An attempt for a student might be taking four pills at bedtime planning to die but waking up the next morning and going to school. Typically, students do not tell anyone about what they did, except possibly a friend.
The Lifelines Suicide Prevention program, which was taught to 15,000 middle school students in Delaware from 2012 to 2014 under DPBHS’ SAMHSA Garret Lee Smith Grant. This program focused on educating middle school students to get help for her friend if she learns a friend is suicidal. All students and adults should respond to a statement related to suicide very seriously.For a student, it would mean telling an adult about his/her suicidal friend. For adults, it would mean offering to help them seek a mental health professional to complete an evaluation. Crisis services are available, for both children and adults, to complete suicide assessments.
Mobile Response and Stabilization Services (children/youth): 1-800-969-HELP (4357)
Crisis Intervention (Adult): 800-652-2929 (Northern Delaware)
800-345-6785 (Southern Delaware)
Suicide Warning Signs:
Get immediate attention for a child or teen who makes statements or displays behaviors related to wanting to harm themselves or die. Warning signs indicate a child or teen is struggling. Too many warning signs might indicate a child or teen is suicidal. Lifelines* uses the word FACTS to remember the warning signs.
Psychosis is an illness affecting the structures and chemicals of the brain that enable us to experience emotions, make judgments, and perceive the world around us. The three most common problems associated with this illness are hallucinations (seeing or hearing things that are not there), delusions (beliefs that are odd or untrue), and disorganization (becoming confused and fragmented when attempting to think or speak). Other symptoms include fearfulness, difficulty making decisions, strong sensitivity to light and noise, problems paying attention, and emotional distress.
Psychotic experiences are actually fairly common. About 10-25% of youth and young adults report having at least one such experience in their lifetime, but in most cases these are mild and do not last very long. For 1 out of 50 youth, these experiences become sufficiently intense, frequent or long-lasting and interfere with daily routines and well-being.
Problematic psychosis tends to appear between the ages of 12 to 25. These are the ages when youth grow from being dependent on adults to assuming responsibility for making life decisions, taking care of one’s self and, eventually, taking care of others. Supporting a young person with psychosis is particularly challenging because the illness sometimes requires that he or she be heavily dependent on family and friends. Meanwhile, the people providing the support have to balance that individual’s need for support with his and her developmental need for independence. Sometimes it can be hard to know what to do.
What is Delaware CORE?
One aspect of treatment for psychosis that is reliably linked to better outcomes is the period of time that symptoms are left untreated, or as it is commonly referred to: “the duration of untreated psychosis” or just DUP. Researchers have long agreed that the more one waits to get treatment the greater the potential for harm. People who engage early on improve their chances for avoiding (or mitigating) episodes and maintaining a more meaningful quality of life.
Over the past two years, a program entitled Community Outreach and Early Intervention (CORE) has been working in Delaware for the purpose of shortening DUP by engaging young people (ages 12-25) who are experiencing their very first signs or symptoms of psychosis. With start-up funding from the Substance Abuse and Mental Health Services Administration (SAMHSA), Delaware CORE has been implementing a program that was developed by the Maine Medical Center nearly a decade ago.
That parent program, called the Portland Identification and Early Referral (or PIER) program, has been effectively improving the quality of life for youth or young adults with early psychosis for nearly a decade. The program’s developers attribute program success to the combined insight of a diverse professional team (e.g., prescribers, occupational therapist, educational specialist, social workers) and careful tracking of an individualized treatment plan for each enrollee. PIER philosophically rejects medicine as a stand-alone intervention and promotes stress reduction and practical problem solving as essential parts of the recovery process. Team members also maintain an aggressive outreach program to help raise public awareness and reduce stigma.
Back in July of 2015, Delaware CORE convened its first two teams (i.e., eight clinicians). Those teams now serve the entire state. The program offers a broad array of services including psychiatric consultation, occupational evaluation and therapy, supportive services for school or work, and inter-family group meetings to promote networking and support. Over sixty individuals and their families have enrolled.
Preliminary outcomes – based on the first 46 enrollees in CORE – are promising.
To learn more about Delaware CORE or arrange to have a team member come speak to you or your organization, call (888) 284-6030 or go to www.delawarecore.com
Our Medical Director, Richard Margolis MD, helps us make sense of new information in psychiatry, addiction, and behavioral health. This article summaries a New England Journal of Medicine review of current literature on neonatal abstinence syndrome, including clinical characteristics, prevention, identification, and treatment.
The incidence of the neonatal abstinence syndrome has increased substantially in the past decade.
The increase in cases of the neonatal abstinence syndrome corresponds with the reported rise in opioid use during pregnancy, which is attributed to the more liberal use of prescribed opioids for pain control in pregnant women, illicit use of opioids such as oxycodone and heroin, and a dramatic increase in opioid-substitution programs for the treatment of opioid addiction. The pattern of opioid use has also shifted from an inner-city, low-income population to a more socioeconomically and demographically diverse population that includes pregnant women. The causes of the neonatal abstinence syndrome are similarly diverse, including in utero exposure to prescribed or illicit opioids and to agents used for the treatment of maternal opioid addiction.
Illicit opioid use is often complicated by a chaotic lifestyle that includes drug-supporting and drug-seeking behaviors. This lifestyle may hinder access or commitment to medical and social services, leading to substantial risks of illness and death. These risks can be mitigated with opioid-substitution treatment, which has benefits for both health and social outcomes. Methadone is currently the most commonly prescribed treatment for opioid addiction during pregnancy, although the evidence suggests that buprenorphine may be associated with less severe neonatal withdrawal than methadone.
The neonatal abstinence syndrome refers to a postnatal opioid withdrawal syndrome that can occur in 55 to 94% of newborns whose mothers were addicted to or treated with opioids while pregnant. Other terms have also been used to describe the syndrome, including the neonatal withdrawal syndrome, the neonatal drug withdrawal syndrome, and neonatal withdrawal. Although the neonatal abstinence syndrome is the term used most frequently in the literature, neonatal withdrawal is probably a more accurate description of the syndrome.
The neonatal abstinence syndrome has been described as a complex disorder that primarily involves the central and autonomic nervous systems and the gastrointestinal system. The clinical manifestations of the syndrome vary ranging from mild tremors and irritability to fever, excessive weight loss, and seizures. Clinical signs typically develop within the first few days after birth, although the timing of their onset, as well as their severity, can vary. This variation is poorly understood and is believed to be multi-factorial. In particular, the type of opioid and the dose and timing of exposure may alter the risk of withdrawal. Clinical manifestations may develop later in infants who have been exposed to opioids with a longer half-life (e.g., methadone and buprenorphine) than in infants exposed to short-acting opioids.
Primary-prevention strategies are needed to address the epidemic of opioid use and the associated development of the neonatal abstinence syndrome. Ongoing surveillance is essential to inform public health–related efforts aimed at prevention. Evidence suggests that in the United States, states with the highest rates of prescription opioid use also have the highest rates of the neonatal abstinence syndrome. Therefore, targeted initiatives to address prescribing practices may help to reduce opioid use in women of childbearing age and prevent the subsequent development of the neonatal abstinence syndrome. Efforts are under way to address the over-prescribing of opioids, such as the introduction of programs to monitor opioid-drug prescribing practices, regulation of pain-management clinics, and establishment of opioid dosage thresholds. Health care providers are encouraged to practice safe and judicious prescribing of opioids to women of childbearing age.
The increased incidence of the neonatal abstinence syndrome and soaring increases in associated health care costs warrant a consistent and comprehensive approach to mitigating the negative outcomes for affected infants, their mothers, and the health care system. Recent innovations in management include standardized protocols for treatment, which have positive effects on important outcomes such as the duration of opioid treatment, the length of the hospital stay, and the use of adjunctive drugs. In addition, evidence from pharmacokinetic models supports the development of empirically based dosing protocols. Breast-feeding and rooming-in are promising non-pharmacologic strategies that may also improve outcomes for infants and mothers, including maternal satisfaction with and involvement in the care of the newborn.