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Wanda Montalvo

Wanda Montalvo PhD, RN

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  1. Suicide Prevention Awareness Month may be over, but mental health remains an issue that demands our constant attention and care. Thankfully, there are resources in place that work around the clock to alleviate the United States’ suicide crisis at any time of day, in any month. But with all the options for individuals suffering from mental illness, it can be difficult for patients -- and nurses -- to decipher the choices in front of them and pinpoint the type of help they need. As a nurse who has worked in federally qualified health centers, I understand the challenge of identifying resources that are both evidence-based, free, and accessible to the public. I have called on Jonas Nursing and Veteran Healthcare Scholars, doctoral nursing graduates and candidates, to share their go-to resources. Whether you are a nurse looking for help to share with patients, family, friends, colleagues, or for use yourself, here are our favorite online, mobile, and telephonic resources for your reference: General Resources Mental Health America For more than 80 years, this community-based nonprofit has been helping people living with mental illness and promoting overall health. The site includes useful resources like screening and decision making tools, in addition to webinars. National Alliance on Mental Illness This is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. The website breaks down step-by-step the process of finding and receiving help, making the intimidating task of tackling mental health achievable. Zero Suicide Prevention The Zero Suicide framework is defined by a systemwide, organizational commitment to safer suicide care in health and behavioral health care systems. This is an in-depth resource for health professionals in identifying and treating suicidal thoughts in others. The Center for Disease Control (CDC) This center offers up helpful research on mental health and suicide prevention, including vital coping strategies to help visitors to the website. The CDC hopes to build awareness of suicide and encourage a commitment to social change. It also addresses the issue of mental health within its CDC Center for Healthy Aging. Behavioral Health Treatment Services Locator This website allows people suffering from depression or suicidal thoughts to research treatment using their zip code to find the most immediate and convenient help available. By making it easier to locate and reach treatment, this website eliminates the logistical obstacle between mental illness and recovery. HHS Office of Women’s Health With a rich array of information to help address mental health, postpartum depression, and post-traumatic stress, this website provides a valuable resource to Women of all ages and stages in their lives. National Institute of Mental Health This website provides a wealth of information on mental health symptoms, conditions, and treatment options geared toward patients, their families, and their healthcare providers. Notably, this resource is available in both Spanish and English. Helpful Hotlines Source: Substance Abuse and Mental Health Services Administration (SAMHSA) National Suicide Prevention Lifeline 1-800-273-TALK (8255) National Helping for treatment referral and information 1-800-662-HELP (4357) Disaster Distress Helping 1-800-985-5990 Resources for Adolescents and Children Health and Human Services (HHS) One in five adolescents has experienced a serious mental health disorder, such as depression and/or anxiety disorders. This site provides the friends and family of struggling teens with tips on identifying early warning signs and ways in which to help them seek treatment methods. National Institute on Drug Abuse for Teens NIH hosts the National Institute on Drug Abuse for Teens and reports 70,200 people died from a drug overdose. The organization provides resources for teens, teachers and parents, including videos, games, and infographics to help combat overdose, both intentional and accidental. Society for Adolescent Health and Medicine Contains guidelines and resources to help health care providers working with adolescent and young adults. The National Child Traumatic Stress Network This website seeks to help children who suffer from traumatic stress who have been exposed to one or more traumas. It offers information on types of trauma, symptoms, and treatments. Sesame Street for Military Families Sesame Street developed this program of engaging stores, which are on a free, bilingual (English and Spanish) website, where families can find information and multimedia resources on the topics of military deployments, multiple deployments, homecomings, relocations, injuries, and grief. Resources for Veterans PsychArmor® Institute This is a national nonprofit providing critical resources to Americans so they can effectively engage with and support military service members, Veterans and their families across our nation. The organization’s online education courses are free to all people who work with, live with or care for this population. #BeThere Campaign This resource helps support Veterans in crisis by matching them up with the resources they need. It also advises family and friends on identifying red flags in a veteran’s social media posts, conversations, and behavior. Veterans Crisis Line This hotline is open to veterans or loved ones of a veteran 365 days a year. Call 800-273-8255 and Press 1, text to 838255 or chat online at VeteransCrisisLine.net/Chat US Department of Veterans Affairs The VA provides a multitude of avenues to receive help for mental illness and suicide prevention, connect with counselors, medical professionals, and other veterans who are experiencing similar struggles. This site also offers mobile resources, including Caring4WomenVeterans, Mindfulness Coach, and CBT-i Coach (for Cognitive Behavioral Therapy). Suicide prevention deserves our attention every day of the year. These resources are invaluable to nurses and patients alike in educating ourselves on the intricacies of mental illness and options in front of us moving forward. I hope this list is helpful to you, your patients, friends and family members.
  2. The statistics are staggering. And they demand action. Over the past two decades, suicide mortality rates in the U.S. ranked second as the leading cause of death those 10-35 years of age,1,2 with the costs related to suicide totaling $70 billion.1,2 In 2017, Suicide claimed the lives of more than 47,000 people, ranking the tenth leading cause of death overall in the U.S.3 To help address suicide prevention, we must be aware of the behavioral health provider shortage. According to the U.S. Health Workforce Chartbook by the National Center for Health Workforce, in 2018 the behavioral health service providers included 217,449 psychologists, 377,763 Counselors, and 609,711 social workers.4 With over 3.8 million active RNs as of 2015,8 nurses represent the single largest group of health care providers and play a critical role in assessing all patients for warning signs of suicidal thoughts as they walk through the door. While all nurses have this responsibility, some have dedicated their studies to the practice, making big impacts in expanding mental health services and suicide prevention. As the experts on the front lines of patient care, nurses have a wealth of knowledge that can be put to good use in creating policy and changing the status quo when it comes to mental health. A persuasive body of research evidence, indicates effective strategies to address mental health issues include four key ingredients: Systematic outreach and diagnosis Patient education and self-management support Provider accountability for outcomes Close follow-up and monitoring to prevent relapse.5 Nursing is a vital lifeline and asset to support these key evidence-based strategies, especially when implementing and monitoring practice guidelines. To illustrate the importance of elevating nurses via education to decision-making positions in this field, I would like to share the advice of Jonas nursing scholars who are actively making waves in mental healthcare in three areas: with veterans, marginalized populations, and nurses themselves: Krista Roberts, Current DNP Scholar; University of Connecticut Roberts’ work focuses on our country’s Veterans -- some of the most vulnerable people to mental illness and suicidal thoughts due to past experiences and service in the military. According to Roberts, “many providers aren't aware of the risk factors associated with suicide in veterans and many aren't even aware that they are treating a veteran.” She advises nurses to remain mindful of whether a patient has a military service history and how that patient’s time in the military may affect how they accept care. “Veterans may be less likely to share information during mental health screenings because of the mental illness stigma in the military that has carried over into their civilian lives,” Roberts says. “Establishing a trusting relationship with a patient who is a veteran is one of the most important steps a nurse can take in order to provide quality care to veterans and encourage them to open up and be honest about symptoms they may be experiencing.” Alasia Ledford, Current PhD Scholar; University of North Carolina-Chapel Hill Ledford is working with American Indian and Alaskan Native women and children in preventing suicide in these particular, and often marginalized populations. She has seen firsthand how historical trauma of these communities is experienced and expressed inter-generationally. “Such things may not always be obvious when taking down the history of a presenting illness, which is why we as nurses need to take the time for suicide assessments,” Ledford says. Because most marginalized evidenced-based research does not acknowledge these marginalized populations as statistically significant, their unique results and needs are often overlooked. “As health care practitioners, nurses cannot ignore the importance of understanding the disparities and inequities faced by this population, and how that impacts mental health,” says Ledford. Her counsel can be applied to any neglected or ignored community in the country. Timothy Burns, Current PhD Scholar; St. Louis University Mental health issues do not just affect patients but are issues that nurses, especially emergency room nurses, struggle with personally. Timothy Burns is working with emergency department nurses to create solutions to improve the care of the people who care for us. “Mental health issues – be it secondary traumatic stress, compassion fatigue, or burnout – were issues that my colleagues struggled with secondary to the provision of their jobs,” he says. Burns encourages vigilance from healthcare staff in looking out for not only their patients but one another. “This vigilance is in each nurse looking out for their colleagues, understanding the signs and symptoms of compassion fatigue, secondary traumatic stress, and burnout, and intervening as appropriate. Succinctly, nurses need to have each other’s backs when it comes to personal mental health issues and suicide prevention.” These three nurses, and all nurse leaders, in fact, play an important role in preparing the nursing workforce to better understand mental health and overcome the stigma or care avoidance for suicidal patients.1,5,7 Recognizing the critical role of health care in prevention suicide, the National Action Alliance for Suicide Prevention (Action Alliance) called for suicide prevention to become a “core component” of health care, and for improved professional and clinical practices.7 A comprehensive system-wide approach to suicide prevention, notably training, protocols, practice guidelines and quality assurance for fidelity are value-added strategies to adopt and sustain suicide prevention practice strategies.7 Thanks to nurses like Krista Roberts, Alasia Ledford, and Timothy Burns, I am hopeful for a future of leadership in facing this challenge head-on with compassion and creative solutions. leading_causes_of_death_by_age_group_2017-508.pdf RESOURCES Brenes, F. (2019) Hispanics, Mental Health, and Suicide: Brief Report. Hispanic Health Care International, 17(3), 133-136. DOI: 10.1177/1540415319843-72 Stone, D. M., Simon, T.R, Fowler, K.A., Kegler, S.R. ….Crosby, A.E. (2018). Vital signs: Trends in state suicide rates-United States, 1999-2016 and circumstances contributing to suicide—27 states, 2015. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, 67, 617-624 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System https://www.cdc.gov/injury/wisqars/LeadingCauses.html (accessed September 19, 2019) HRSA (Human Resources and Services Administration) 2018, National Center for Health Workforce Analysis. The U.S Health Workforce Chartbook. Part IV: Behavioral and Allied Health. https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/hrsa-us-health-workforce-chartbook-part-4-behavioral-and-allied-health.pdf (accessed September 18, 2019). IOM (Institute of Medicine). 2012. The mental health and substance use workforce for older adults: In whose hands? Washington, DC: The National Academies Press CDC (Center for Disease Control) Depression is Not a Normal Part of Growing Older | Healthy Aging | CDC https://www.cdc.gov/aging/mentalhealth/depression.htm (accessed September 19, 2019. Grumet, J. G., Hogan, M. F., Chu, A., Covington, D. W., & Johnson, K. E. (2019). Compliance Standards Pave the Way for Reducing Suicide in Health Care Systems. Journal of Health Care Compliance—January–February, 17. Journal of Nursing Regulation, The 2015 National Nursing Workforce Survey