Riverside County 2022-23 Civil Grand Jury Suicide: a Tragedy Affecting All of Us – Riverside County Data & Local

Additional Recommendations 1

These recommendations are not explicitly linked to specific findings.

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  years of age. The latest CDC report also confirms ongoing and extreme distress among teens who identify as lesbian, gay, bisexual, or questioning. The report also found more than half (52%) of LGBTQIA+ students had recently experienced poor mental health, more than 1 in 5 (22%) attempted suicide in the past year, with particularly stark increases of harmful experiences among teen girls: • Nearly 1 in 3 (30%) seriously considered attempting suicide – up nearly 60% from a decade ago • 1 in 5 (18%) experienced sexual violence in the past year – up 20% since 2017, when CDC started monitoring this measure • More than 1 in 10 (14%) had been forced to have sex – up 27% since 2019 and the first increase since CDC began monitoring this measure • Compared to their counterparts, LGBTQIA+ youth and female youth reported greater levels of poor mental health; emotional abuse by a parent or caregiver; and having attempted suicide46 Palm Springs, Cathedral City, and Rancho Mirage are among the top 10 small cities in the nation with the most same sex households. Of that population, 65% have reported emotional and mental behavioral concerns in 2021. In the Inland Empire there are an estimated 27,000 transgender people and 82% have considered suicide in their lifetimes.47 45 From LGBT to LGBTQIA+: The evolving recognition of identity 46 New CDC data illuminate youth mental health threats during the COVID-19 pandemic 47 Community Health Needs Assessment Report, Desert Healthcare District and Foundation, September 2, 2021 19 In our investigation, services to the LGBTQIA+ population seem to be more robust in the Desert region of the County, or available via hotlines and websites. This network would be beneficial if it were replicated throughout the County. For a listing of County LGBTQIA+ suicide prevention and early intervention resources, refer to Appendix A8. Conclusion Given the data presented in this report, building life skills, such as coping and problem-solving skills, emotional regulation, conflict resolution, and critical thinking are important in protecting individuals from suicidal behaviors. Impulsiveness and aggressive behavior seem related to suicide. Furthermore, after one suicide attempt, another will likely follow within weeks, months or even up to two years. Currently, Riverside County suicide prevention services are attempting to meet the needs of this growing public health trend. • However, the dearth of county-specific data is a barrier to understanding the real impact of suicides and creates preventable challenges to service provision. Improving or expanding suicide prevention services does not guarantee that they will be used by the people most in need, nor increase the number of people who follow recommended referrals or treatment. • Accessibility is key. As a model for what works, it is recommended to enhance partnerships. It is paramount that counselors, social workers, health care providers, project managers, city council members, law enforcement, etc. come together and Riverside County’s Suicide Prevention Coalition have done just that, their first annual conference in October 2022, and quarterly meetings open to the public via zoom. • Gatekeeper training for teachers, coaches, clergy, emergency responders, primary and urgent care providers, and others in the community that have interactions with people who could be at risk for suicide, can lead to better and effective responses and guidance. • Suicides increase during economic recessions, so strengthening economic supports (i.e., unemployment, livable wages, medical benefits, housing, government subsidies, loan modifications, financial counselling) are vital. There are, nonetheless, reasons for optimism. • RUHS-BH continues to expand and enhance its 79 operational sites, 140 community based organizational sites, 100 school sites, and services to 60,000+ consumers per year. • In May 2022, California’s Governor announced $50 million for the establishment of the California Veterans Health Initiative (CVHI). The CVHI will deliver a comprehensive, coordinated statewide approach to ending veteran suicide by focusing on prevention, early intervention, and direct services to effectively combat the risk factors associated 20 with suicidal ideation. The CVHI will bolster awareness, outreach, and education efforts, as well as an increase capacity through coordinated support of the community-based systems of care. The Initiative consists of three main components, including: o Outreach and Education Campaign ($5 million). To address the risk factors associated with veteran suicide through an awareness campaign that educates veterans, stakeholders, partners, and the broader community on the knowledge, behaviors, and attitudes surrounding veteran suicide. The campaign will target prevention activities, and promote health and wellness. o Veteran Mental Health Support Network ($40 million). To expand access to mental healthcare for veterans and their families by supporting a network of veteran-specific mental health clinics throughout the state. Crisis intervention and treatment would be inclusive, equitable, and available to veterans regardless of age, period of service, type of service, discharge status, or disability rating. o Veteran Suicide Surveillance and Review Program ($5 million). To establish a multidisciplinary team of professionals and stakeholders focusing on the identification and collection of veteran specific suicide data. Additionally, the team will coordinate a statewide assessment of veteran’s mental health and provide recommendations on future prevention, intervention, and post- intervention strategies.48 • California’s Governor plans to build 1,200 small homes across the state for the homeless at a cost of $30 million (budget is inclusive of land, or rent of the land, construction, maintenance, etc.). Federal government requires cities to have shelter beds available before clearing out homeless encampments. FINDINGS F1: The Civil Grand Jury finds county-specific suicide data collection is deficient. Without local data, the extent of the problem is not clear and suicide prevention services and programs will not be appropriately designed. F2: The Civil Grand Jury finds two observations during this investigation: (1) Despite reasonable efforts to improve the design of forms and to establish single points of contact, citizens still perceive intake forms as cumbersome; and (2) Citizens expect governments to act proactively by initiating appropriate government services themselves, instead of relying on requests for services from users. Therefore, offering County residents the convenience of having multiple needs met in one physical location is a continuing need. California Veterans Health Initiative to Combat Suicide and Address Mental Health 21 F3: The Civil Grand Jury finds Riverside University Health System – Behavioral Health has significant partnerships with Riverside County agencies and community partners to serve the needs of County residents. F4: The Civil Grand Jury finds that 988, the newly established Suicide & Crisis Lifeline, diverts Riverside calls through the Los Angeles County call center. Upon identifying as a Riverside resident the caller is referred to a secondary number. Though interpretation into over 240 languages and dialects is marketed as available 24/7 with average time to be connected to an interpreter within 17 seconds, this was not our experience when requesting interpretation. F5: The Civil Grand Jury finds that the Riverside County Board of Supervisors Youth Commission and its five Youth Advisory Councils has the capacity through its relationship with schools and youth to advise the Board of Supervisors on youth suicide prevention. F6: The Civil Grand Jury finds that military veterans are currently served by a core committed team at the Riverside County Department of Veterans' Services. However, staffing and budgeting constraints have hampered the team’s capacity to connect veterans to the many resources available at State and Federal Veterans Administration. F7: The Civil Grand Jury finds that a telephone behavioral health assessment could be an effective approach for identifying and managing behavioral health issues in older adults, perhaps paving the way for alternative ways to seeking and receiving mental health help among the homebound.49 F8: The Civil Grand Jury finds that services to the LGBTQIA+ population exist in a patchwork fashion and mostly through non-profit agencies. A more visible and focused strategy at the County level is not apparent. RECOMMENDATIONS R1: The Civil Grand Jury recommends the Board of Supervisors support more delineated county-specific suicide data collection through Riverside County Epidemiology Program Evaluation and its community partners. Based on Finding(s): F1 Financial Impact: Moderate Implementation Date: June 30, 2024 49 Validation of telephone-based behavioral assessments in aging services clients. Yeates, Conwell, Epub 2017 Sep 20 22 R2: The Civil Grand Jury recommends the Board of Supervisors focus on creating a more connected systems approach (inclusive of all County agencies) for County residents seeking resources. Consider implementation and enhancement of “one-stop shop” strategies from proven, evidence-based, government administration models by bringing together County services in one location that can benefit all residents in accessing healthcare, transportation, referrals, and services. Based on Finding(s): F1, F2, F3, F5, F6, F8 Financial Impact: Moderate Implementation Date: June 30, 2024 R3: The Civil Grand Jury recommends the Board of Supervisors to continue supporting and enhancing the implementation of model suicide prevention programs and strengthen existing programs that foster social emotional growth, trauma-informed practices, continuity of care, and a continuum of crisis services across the County. Specifically, enhance applicable programs and services within Riverside County Suicide Prevention Coalition (to expand services), Housing Authority of the County of Riverside (to stabilize housing), Riverside County Office on Aging (to assist older adults), and the Youth Commission and its five Youth Advisory Councils (to advise the Board of Supervisors on youth suicide prevention). Based on Finding(s): F3, F5, F6, F7, F8 Financial Impact: Minor Implementation Date: December 31, 2023 R4: The Civil Grand Jury recommends Riverside University Health System - Behavioral Health to continue supporting the work of Riverside University Behavioral Health Commission & Regional Advisory Board and its many Standing Committees (Adult System of Care Committee, Children’s Committee, Criminal Justice Committee, Housing Committee, Legislative Committee, Older Adult Integrated System of Care Committee, and Veteran’s Committee). Consider behavioral health assessments among the aging via telephone in Riverside County as an effective approach for identifying and managing behavioral health issues in older adults and as an alternative way to seek and receive mental health help among the homebound. Based on Finding(s): F2, F3, F6, F7, F8 Financial Impact: Minimal Implementation Date: September 30, 2023 R5: The Civil Grand Jury recommends Riverside University Health System - Behavioral Health continue evaluating crisis team services to identify gaps in service provision and potential funding sources. Based on Finding(s): F3 Financial Impact: Minor Implementation Date: March 31, 2024 23 R6: Though Riverside County has expanded its trainer base for Frontline and Gatekeeper training (ASIST50, SafeTalk, Mental Health First Aid, and Know the Signs) and established El Rotafolio as a Spanish version of SafeTalk, the Civil Grand Jury recommends Riverside University Health System-Behavioral Health to enhance training for RUHS social workers to look for and recognize signs and symptoms of potential suicides during home visits and County detention center mental health program intake. Based on Finding(s): F2, F3, F6, F7, F8 Financial Impact: Minimal Implementation Date: March 31, 2024 R7: The Civil Grand Jury recommends the Board of Supervisors and Riverside County of Education partner to: 1. Collect more delineated Riverside County specific suicide data. 2. Continue to place more mental health care services in school and community settings. 3. Enhance partnerships between schools and County programs. 4. Be fully aware of the limitations of 988 as a resource until services are more operational, and work with the Los Angeles County call center to improve 988 service to Riverside County residents. Based on Finding(s): F1, F3, F4, F5, F8 Financial Impact: Moderate Implementation Date: September 30, 2023 REQUIRED RESPONSES Pursuant to Penal Code §933(c) and §933.05, and Board of Supervisors policy A75, , F2, F3, F5, F6, F6, F7 R1, R2, R3, R6 • Housing Authority of the County of Riverside F2, F3 R2, R3, R4 • Riverside County Office on Aging F2, F3, F7 R2, R3, R4, R6 50 ASIST Suicide Prevention Training Program 24 • Riverside University Health System, Behavioral Health F2, F3, F4, F7, F8 R2, R3, R4, R5, R6, R7 • Riverside County Office of Education F4 R7 • Riverside County Department of Veterans' Services F2, F3, F4, F6 R2, R4, R6 • Riverside County Epidemiology Program Evaluation F1 R1 • Riverside University Health System, Behavioral Health Commission F2, F3, F7, F8 R2, R3, R4, R5, R6 Invited Responses • Desert AIDS Project (DAP) Health • Desert Healthcare District and Foundation