Good morning, good to see so many folks here. It's quite encouraging and I commend you for being here. I thank you, Ann Robbins, for putting this together and those were great initial comments. I like Supervisor Yamaguchi your option versus solution, that was very good. And I did want to note at break, though, what were the other three bumper stickers on that car? I thought might be very insightful there to get some. But let's see. Does this thing work here? I'm not sure. I'll see if I can do without that. I am a physician but I was trained in family practice and I've been doing public health for the last 16 years here in Butte County. It's been a great place to work. We've enjoyed doing work in corroboration with Butte County Behavioral Health. We've had most recently work in drug treatment and it's been very rewarding to work with Behavioral Health in that area. I got to tell you one story. And that is that I was reading through my journal and I came across recently I recorded that I'd had a dream. Being you're all behavioral health people, you're into dreams; aren't you? Or, I mean, you like dreams. But I had this dream and I don't remember very many of my dreams but this one I had written down. I got a call from the state emergency operation center. One thing we do in the health department is we respond to disasters. So I got a call from the state and the person on the other end of the line, a woman, who was kind of upset said Dr. Lundberg, there's a porta potty that's floating down one of your rivers. And I thought that's interesting and then laughed at myself because the next question I asked her, and I think I woke up laughing was, "Is there anyone in it?" I thought well that is an appropriate question. So anyway, I'm going to leave you with that right there. Maybe you behavioral health folks can help me with that. 1
We do register in public health department all deaths in Butte County. All births and deaths. And, you know, we have a deputy registrar who does that work and it's hard work for her. It's hard work because every death certificate is a crisis in someone's family, in someone's loved ones. It's easy to look at it just as data and we are going to look at some data today and they are death data. But we need to remember and as I was looking through the death data and I was looking through individual death certificates, I was just struck by how each one of them you know, I started to read a little bit about their ages and where they lived and every one was associated with tears and a crisis. And so as you look at our death data for Butte County in 2009, these are the numbers. So you can see that, you know, we have suicide in the top ten. You can kind of see the proportion of the numbers there. Heart disease is the No. 1 cause of death or heart related diseases, cancer. 2
And the other thing that you need to realize is just that I'm going to be showing some death data. That's just the top of the pyramid. What we're trying to do is there's a burden that suicide or suicide ideations or suicide attempts have on our system. And this is just for the United States, but the top of the pyramid we review that as deaths but there's a lot of hospitalizations that occur. This rate is per 100,000 so nationally they're reporting 15.2 per 100,000 deaths. Hospitalization rates is 86 and then here's emergency room visits that are for suicide behaviors so there's quite a burden that is put on the system. 3
As we look at our data, these are the rates of suicide by year in Butte County. Now, as we look at these rates, you know, I think it's important at this conference that you looked at these numbers because it's important to understand our numbers. There are limitations in the data that I'm showing you. Some of the data is, as I match it with the State's data and the State is the one that finally gives our final numbers and reviews all of our death certificates. I notice at times our numbers don't agree and I don't entirely understand that. We try to keep a running total of some of these important statistics. But I think it's an accurate sample. The numbers I'm going to show you is an accurate sample of the suicides of Butte County. And I do think it gets us close to sort of understanding. When a suicide occurs in Butte County all of them are investigated by the coroner's department. Some are assigned suicide designation right from the start, but some have to be investigated. Some circumstances don't lend themselves to being clear what happened. So some of are investigated and later they're assigned. There certainly would be other data I wish I could find. There's data that would really help us, I think, in understanding suicide. It would be great to know how many crisis line calls occurred in Butte County citizens. I don't have that data. I don't know if we could find that data. Wouldn't it be nice to know how many hugs per capita that was occurring in Butte County? That would be kind of interesting date point; wouldn't it? I mean that would tell you something about the mental health maybe smiles per day per person or encouraging words per person. But we have limited access to our data. But let's look at what we have. So here's by year. You know, starting in 2005, this is a reported number of suicides in Butte County. You know, as you look at that, of course, that's a problem. I mean we'd love to have zero up there, but what can we learn? Do we have a risk factor in Butte County? Are we unique in any way? Is there a unique problem to 4
Butte County? Why is this occurring? I think these are the kind of questions that, you know, you see that kind of data and you need to ask. 4
Well, I don't intend to read this but I do have it if anyone needs it. This is called a Butte County Health Status Profile. Every year the State puts out a summary of important indicators of health. 5
On there is suicide and if you want these, I have a bunch of copies. I think they're useful for grant writing. They're useful for your agencies to understand some of the impacts of diseases in our county. But here's the top section of that. It's mortality data. So this is the State puts out this data here. And if you can see one of them is suicide. I think that cut off a little bit over here, but just to tell you what they put in here. Over here this should say "rank order" and they rank us compared to the other 58 counties in California. And you can see these numbers over here are on the not good side. You see a lot of 50s you can see that suicide that should be a 45 down there. If you come across, they have crude the death rate, total deaths, average deaths over a three year period of time what that would be for deaths per 100,000. Then they do what's called an age adjusted death rate. That's so we can compare county to county because some counties would have a distribution of age that would make them either more at risk for suicide or less at risk. So to try to make sure that the counties are compared equally, we have a process in biostatistics to try to equalize that out. So that's actually what they use to rank us and then we have a national objective. The national objective stated is 4.2 suicides per 100,000. The current national age adjusted is 11.6 and ours is 16.4. 6
And the state wide is, I think, is I put that here in a better way. There again was our average number of deaths over that three year period of time. The crude death rate, again, is number per 100,000 in Butte County. The age adjusted, that's the national objective. That's the current national number 11.6 per 100,000. And state wide current number is 9.6. So just right there looking at the state wide, why are we different? Why is our number 16.4 and the State is 9.6? What is unique about Butte County that makes us almost double the risk? If you're competitive people, you always want to be No. 1; don't you? I want to be No. 1. 7
And you know when I see a rank order and I see where we line up, I say why can't we be No. 1? Why can't we be the best? Well, who is up at the best here? I thought it was a little interesting at the top when you talk about rank orders, and these are now by suicide rank orders among California counties, it's interesting, Glenn County was up there, you know. This little asterisks means that their numbers are so small that there's an issue of confidence in that number but that may be something to look at. I don't know if there's something unique about Glenn County. But then as you go down you see who is doing better. Here's the California, kind of average. 8
Then as you go down in the bottom, looks like just as our previous speaker said, a lot of rural counties are over represented in that bottom part of the suicide rates. I yellowed out the ones that are close by to us. You know, here we are Tehama, Shasta County. Then the other way, you know, you'd think that maybe that a county can make some kind of intervention over time, and relative to the other counties, we might be able to change our ranking. 9
But it's interesting that if you look over time, we really haven't changed our ranking. I looked at a ranking from 1999 to most recently and so, you know, we really haven't changed our ability to make an intervention to change our suicide rate relative to the other counties to try to move ourselves. I mean all counties are trying to make a difference but how. If we were to do some incredibly successful program or something really, really unique to Butte County, you know, you'd think we might be able to make our ranking change relative to the other counties. You can see over time we've been in the 40s compared to other counties. So that's where we've been. 10
Now looking at some of the age ranges from the years 2007 to 2011, 2011. That's a little hard to see. This is initially how I broke it out. Just, you know, each age group. This is the 18 to 25, under 18. 11
So I just combined them there so I added all the years together for the age range. Again, I know that this is not every suicide in Butte County. I don't think my data that I had captured every case but I think it's a good sampling of our death suicides. And so, you know, we've had a couple of 17 year olds over that period of time. Oldest was 92. But these are the age breakdowns. I just lumped them into these 18 to 25, 26 to 39, 40 to 49, 50 to 59. So this is over that period of time. There's where the ages broke out on our suicides. 12
Percentages of the suicides in that, you know, 24 percent of it came from this 50 to 59 year olds. 13
This is how we broke out, male, female. You know that men are more likely to be successful. Women are more likely to attempt suicide. That's our data. 14
Just in one year. I only had complete death certificates for this 2011, 2011, but these were the months of the suicide. I don't look at this very often. I was a little surprised. I thought maybe more would happen in, you know, they always talk about more depression at least for that year, it was in the middle of summer where we had more of our suicides. 15
Just for this one year. I think, you know, just to see how it might have broken out, this is just one year of data, how the cities broke out. Oroville, and Paradise, Chico. The other were Forest Ranch and Durham. And we had one suicide that year of someone who lived in the Sacramento area that came up here and committed suicide here in Butte County. It got registered as our death. 16
Another data set I wanted to show you. You can find it on the internet. It's called the County Health rankings. And it describes some health issues that might be pertinent today. 17
You know, in there, one of the issues they talk about describing your county. Down here is poor mental health days. This particular survey comes from a phone survey, random digit survey of the populations 18 and older who have a land line, so you have to have a land line. There were 567 interviews that happened in Butte County and they asked the question thinking about your health mental which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? And so that question was asked all across the country to 567 people in Butte County and that came out to 3.8 days. And you can see the national number was 2.3, really close to the California average on that. Another part of that particular survey is mental health providers by county. 18
And this here would be population per mental health provider. And in that case they defined that as a psychiatrist, a clinical psychologist, a clinical social worker, a psychiatric nurse specialist, or a marriage and family therapist who meets certain qualifications and certifications. So when they did this particular survey of our county, they found that this is the rate of mental health providers in Butte County so you can see that we're quite a ways off. We're underserved in mental health. 19
Another way to look at that is just look at their list of counties. Like Marin County, are you surprised that they might have the most per capita? So they have 559 for population, you know, of 248,000 for a mental health worker ratio of 444 to 1. 20
You can see that, you know, for Butte County, we're down here, I think, that's like No. 34 on the list. The 62 mental health workers were listed in whatever way they counted that so. You know, there's Shasta with 48. So you can see that that's quite a range. You know, I would say we're not as bad as some in having mental health coverage in Butte County. But if you just keep going down the list. 21
Interesting, Glenn County that has the best suicide rates only had one. What does that say? I don't know what that says, but they only have one worker they characterize there. But Yuba County, Colusa County, Sutter County. Now I'm not trying to say anything there now, but I know that on the physician side of things, on public health side, that's certainly one of the challenges we have in Butte County is we are underserved in primary care and internal medicine also. It makes a difference in getting services. 22
I'm pulling from public health literature. This was a great study called Suicidal Thoughts and Behaviors Among Adults. And it was a nice study. 23
You can see it's fairly recent and so in there I thought this is one of the tables that I thought, you know, among fatal I think the data was already kind of shown here. Among the fatal suicides across the country, most are firearms. Among the nonfatal suicides, poisoning, cutting, and suffocations are there. That was the breakdown. 24
Here is just the case fatality rates among men. All men who attempt suicide. And what about 12 percent are successful. So the case fatality rate in women are much smaller in those who commit suicide or try. If you use a firearm, you're much more successful, you know, not 100 percent though. Suffocated or hanging, common Butte County too. 25
Another needed data set I just want to point out I thought was another public health literature one. It comes from the Youth Risk Behavior Surveillance across the whole United States. And I want to just pull one piece of information out of that I thought was remarkable to me. 26
I couldn't hardly believe it. I'm wondering if I'm reading this wrong. But among high school students in the United States, they're reporting that 18.7 percent of females versus 10.3 have considered suicide that are high schoolers. And the other one is planned a suicide. 13.4 women and 9.2 percent of men have planned. And 9.3 percent of women and 4.6 percent of high school men have attempted suicide. Is that right? My, that is remarkable; isn't it? I mean you look at that number, you know, how many high school students do you know? I mean and you'd say, well, I know some so that means some of the ones I know are going to fit in that data there. That's what was remarkable to me. I don't look at this data. You folks do more. That was very that was very alarming to me and although in our own data for Butte County, you know, we only had in the data set I could pull together, five years, there's just 2 17 year olds or 2 18 year olds. They may have been high schoolers well, this is my last really important slide and what this is to remind me is that I do have an interpretation for my deem. Okay. I told you my dream. This is the river; right? So here's I'm in a river of life and I'm flowing with time down the river of life surrounded by my neighbors, my friends, my family, my colleagues. Some of us flowing down that river have an easy time and some of us are having a perilous time. In fact, some people you might say are going down the tubes or might say in the pot or in the porta potty pot. And I want to be watching for those perilous people. I want to respond to those people in peril. I want to help those people and I want to comfort those people. And I am glad you are here to try to do the same. So thank you very much and that's nice to be with you. Thank you. 27