Cheryl L. Meyer

Development of the Competency Assessment Tool – Mental Health, An Instrument to Assess Core Competencies for Mental Health Care Workers

As the focus on accountability in health care increases, there has been a corresponding emphasis on establishing core competencies for health care workers. This article discusses the development of an instrument to establish core competencies for workers in inpatient mental health settings. Twenty-six competencies were identified and rated by mental health care personnel on two subscales: the importance of the competency and how much behavioral health care workers could benefit from training on the competency. The reliability of the scale and its contributions to the training, retention and recruitment of direct care workers for behavioral health are discussed.

Evaluation of Social Marketing Efforts Designed to Increase Enrollment in the Children's Health Insurance Program (CHIP)

ABSTRACT Expanded eligibility criteria for children in the federally funded Child Health Insurance Program (CHIP) has created unique social marketing challenges because of the need to engage families that historically have not received public support. The purpose of this article is to evaluate statewide outreach strategies to increase CHIP enrollment. Quantitative research identified the outreach strategies used by Ohio counties and determined the counties that demonstrated the greatest increases in child health insurance enrollment. Qualitative research explored consumer and outreach staff perceptions of which marketing strategies led to success. Findings, implications, and application to social marketing theory are discussed.

Severe Mental Illness

This chapter examines the role of severe mental illness in suicide. Understanding motivations for suicide cannot be complete without addressing the way in which mental illness interacts with other risk factors and triggering events. Among our overall sample, 656 of 1280 cases were identified as having psychological problems. Victims were most often diagnosed with depression (75%), bipolar disorder (7%), schizophrenia (2%), multiple diagnoses (9%), and miscellaneous other diagnoses (7%). The presence of any kind of mental illness can increase the risk of suicide, but the most prevalent mental illness found in completed suicides is clinical depression.

Chapter 10 – Conclusions and Implications

Those close to a person who is suicidal are best able to intervene, but prevention requires a much larger, multifaceted effort. In this chapter we examine the idea of a national agenda to create broad based solutions to the problem of suicide, but we also look at how people can implement intervention and prevention programs at the local level.

Protective Factors and Resilience

This chapter examines protective factors in greater depth. Books on suicide all examine motivations for suicide, but often do not examine the motivations for living. The mundane and ordinary aspects of life sustain people, and an approach to combatting suicide that recognizes those positive factors builds on what already exists. It is possible to construct communities that promote and foster social support systems, healthy lifestyles, and full use of people’s skills and gifts. This includes finding a reason to live, and that often comes from having responsibility—though not at such a level that it is overwhelming.

Chapter 3 – Suicide Motivated by Interpersonal Relationships

This chapter examines interpersonal relationships as a motivation for suicide. Conflict in interpersonal relationships, specifically with intimate partners, was the motivation for approximately one-fifth of our cases. Two main categories emerged: suicide related to intimate partners and suicide motivated by other interpersonal relationships. Three subgroups emerged within suicide related to intimate partners: unrequited or lost love (45%), abusive relationship (30%), and unknown cause (24%). For these groups, the suicides may have represented different ways of achieving balance in a relationship that had become imbalanced. Suicides that are due to interpersonal conflict with other family members represent other dynamics and may be tied to perceived burdensomeness. One subgroup that emerged within this category was murder-suicide. A detailed explanation of these categories and our findings are presented in this chapter.

The History and Theories of Suicide

This chapter examines history and theories of suicide from the early modern period to the present. It examines changes in suicide practices, methods, and motivations. The suicides which occur in America today are consistent with those that occurred in the past. The historical focus will be on the peoples of North America who are of Native American, European, and African for the trends established there. Additionally, theories about who commits suicide and why are explained to establish the current state of the field of suicidology.

Chapter 2 – Findings

This chapter examines deaths that were determined to be by suicide which occurred from 2000 to 2009 in Montgomery County, Ohio or the surrounding counties. We had a copy of suicide notes for a small subset of individuals (174 or 14%) while 1106 individuals did not leave a note. The average age of the victims was 45 with a range from 11 years old to 94 years old. The vast majority (92%) were Caucasian and male (82%). The most common method used by individuals to kill themselves was firearms (51%) and a majority killed themselves at home (74%). We delineated eleven categories related to suicidal motivation and two of these categories accounted for more than 90% of the motivations for suicide; interpersonal relationships (23%), and escape (70%). This chapter contains a more detailed explanation of our methodology and our findings, as well as an examination of the similarities and differences between note writers and non-note writers.

Grief and Failure

The motivations discussed in this chapter represent a very small proportion of individuals in our sample. One group (60 people) committed suicide because of grief issues (31 people), while others felt like a failure in life (22 people). We examined specific patterns that can be seen within both the bereavement and failure categories, which can provide information about risk and protective factors.

Chapter 6 – The Complexity of Suicide Motivation

The 174 individuals who wrote notes actively sought to express their thoughts, desires, or emotions. They wanted to leave instructions, apologies, and explanations. Those direct communications helped inform us as to what motivated them to take their own lives. There are very different characteristics among and between groups of people who kill themselves. Prevention and intervention must be tailored to fit the groups. We summarize our findings as they represent multiple and complex motivations, and offer a simplified template for understanding motivations and risk factors. Diagrams help to visually depict the dynamics and characteristics of the groups who committed suicide.