I have been advocating for changes in suicide prevention in Indian Country (areas in the U.S. with high populations of American Indians have very high rates). As a member of the American Indian/Alaska Native Task Force on Suicide Prevention and a presenter at conferences and task force meetings, I present a rather targeted approach to identification of potential suicide victims using the ACE criteria. If you look at the number of Kaiser Permanente subjects in the ACE Study, about 6% of the population had 5, 6 or 7+ ACE’s. Within that group, the cohort of 7+ attempted suicide at a rate of 35.2%, 6 at a rate of 21.8% and 5 at a rate of 13.8%. Clearly, higher rates of suicide are clustered among those with 5+ ACE’s.
Now look at ACE’s for those who go to prison. One study found that 35% of women in prison have 5 or more ACE’s. That total is about 6 times the ACE Study cohort. Extrapolating this information tells us that rates of attempt among prisoners will be significantly higher than among the general public.
My other expertise is as an expert in a method of management referred to as Lean Thinking. I developed this expertise as a CEO for two Alaska Native non-profit organizations. Both organizations had significant management issues and I was able to transform one using Lean Thinking. The other is another story. Lean is basically the management system developed by Toyota over a practice exceeding 70 years. Elements of Lean have been adopted by U.S. businesses in the past as Total Quality Management and Just in Time Inventory. But without a full use of the system, only about 7% of lean implementations succeed. That’s a shame for the public, who receive less than optimal service. And in prisons, poor services often lead to death, sometimes by suicide. A case from the Native Village of Hooper Bay was recently resolved by litigation at a cost of $900,000 from the state of Alaska. [LINK HERE] And the cost of our local government was far greater than $900,000 when you look at the cost of litigation (judges, defense attorneys, lost time for depositions and discovery, management time and a host of others smaller expenses for clerks, copying and clerical).
King County, Washington (Seattle is located within King Country) adopted Lean Government as their management system in 2009. I came across this report about how they addressed the risk of suicide in the jails they operate. [LINK HERE] Here is what was reported:
“Dramatically improving psychiatric observation of jail inmate Inmates classified as suicide risk require observation every 15 minutes, but on an average day at the King County Jail 70 inmates were being given that designation, a rate far above industry standard. Intensive Lean work revealed the absence of clear definitions, along with redundancy and rework that led staff to classify many low-risk inmates as psychiatrically impaired — whether warranted or not.
Once the need for clear standards was identified, the number of inmate-patients on 15-minute checks dropped by 90 percent, from 70 per day to around five. Patients are now evaluated sooner and with greater accuracy, which has also improved the quality of care by providing the right treatment based on condition – saving more than $2 million a year.”
Using a systemic management approach to identification of at risk prisoner in King Country helps prevent suicides and funding.
One issue we have with advancing our work on ACE identification and healing in Alaska is our current fiscal crisis. Budgets are being cut. And despite having over 24,000 people employed by the state, many of our programs are still performing poorly. The Hooper Bay suicide settlement has been overshadowed by the death of another Alaska Native in the jails in Juneau, which happened in what has been reported as a rather callous act. [LINK HERE] Our Alaska Division of Public Assistance had staff of 500, a client base of 150,000 and a backlog of applications for assistance of about 10,000 last November. People in need are not being served effectively.
If you advocate for recognition of ACE’s and for ACE’s to be addressed by government policy, you will hear politicians complain about not having enough resources to deal with the problem. I respond by telling them about the benefits of Lean Government (and am promptly ignored) along with the substantial savings that accrue from intervening early with trauma healing (which most politicians also promptly ignore).
I would encourage you to learn a little bit about the benefits of Lean Government as a management system and encourage your politicians to look at it. Washington State, Colorado, Iowa, Wisconsin and others have with considerable benefit. If we want to reduce suicide rates, we need good resources and analysis. This is a way to achieve it.
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