Health Advocacy Campaign for Suicide Prevention
Instructions: The final application builds upon the applications (Parts One and Two) completed in weeks 4 and 7.
To complete the final section of your paper:
Review provisions 7, 8, and 9 of the ANA Code of Ethics in relation to advocacy for population health.
Reflect on the ethical considerations you may need to take into account in your advocacy campaign.
Research the ethical considerations and lobbying laws relevant to the location where your advocacy campaign will occur.
Consider potential ethical dilemmas you might face in your campaign.
To complete: Revise and combine Part one (week 4 application) and Part Two (week 7 application) with Part Three below.
Explain any ethical dilemmas that could arise during your advocacy campaign, and how you would resolve them.
Describe the ethics and lobbying laws that are applicable to your advocacy campaign.
Evaluate the special ethical challenges that are unique to the population you are addressing.
Provide a cohesive summary for your paper.
Solution.
Health Advocacy Campaign for Suicide Prevention
Advocacy Campaign for Suicide Prevention
Suicide is a growing concern; it affects all ages, races, income levels, and ethnicities. Per HealthyPeople.gov website, “…suicide is the 10th leading cause of death in the United States, accounting for the deaths of approximately 43,000 Americans in 2014.” Individuals, who experience, depression, financial stress, bullying, physical or emotional abuse, and pressure from peers, school, or work, may feel overwhelmed and resort to thoughts and actions of suicide. With prompt intervention, the individual with suicidal tendencies can be treated. Therefore, it is vital that communities implement an advocacy campaign to address the issue of suicide.
Warning Signs
Identifying individuals at risk is vital to the prevention of suicide. The National Institute of Mental Health (NIMH), lists the following as signs to watch for in yourself or others:
- Talking about wanting to die or to kill oneself
- Looking for a way to kill oneself, such as searching online or buying a gun
- Talking about feeling hopeless or having no reason to live
- Talking about feeling trapped or in unbearable pain
- Talking about being a burden to others
- Increasing the use of alcohol or drugs
- Acting anxious or agitated; behaving recklessly
- Sleeping too little or too much
- Withdrawing or feeling isolated
- Showing rage or talking about seeking revenge
- Displaying extreme mood swings.
Being aware of the signs of suicide is not enough. Family members, friends, and communities must get involved in making citizens aware of the fact that help is available, and how to locate it when needed. It is especially important since people may be afraid to seek out help. Unfortunately, a stigma is attached to mental illness. Education is a priority, mental illness is a disease, one should not be embarrassed by their situation. Providing hope to the hopeless is essential in the prevention of suicide.
Advocacy Campaigns
According to Kindig, Asada, and Booske (2008), the goal of health promotion is to improve the health of individuals. In September 2015, Magellan Health along with other prevention organizers launched a campaign titled 22to0. The 22to0 campaign geared towards all individuals who are thinking about suicide. However, the number 22 represents how many veterans commit suicide on a daily basis, which averages about 8,000 veterans per year. The hope is to reduce the number to 0.
“The 22to0 campaign is aimed at establishing an “Early Warning System” which encourages individuals to look, listen and ask courageous questions…” (Mental Health Weekly, 2015, p. 5). During the month of September 2015, which is Suicide Awareness month, the 22to0 campaign focused on awareness through social media, such as Twitter, Facebook, and LinkedIn. The campaigns focus devoted the message to four specific areas such as signs to look and listen for, ask questions, and deliver hope.
The second campaign focuses on a suicide awareness campaign in Cuyahoga County, Ohio. The motto of the campaign is, “Suicide Is Preventable. Its Causes Are Treatable. For immediate help call (emergency number)” (Oliver et al., 2008, p. 246). For this campaign, advertisements, in the form of posters, were placed on bus stops, buses, malls, streets, and sidewalks. A local television commercial advertised the campaign a total of 288 times. This campaign ran for four months on two separate occasions. Results indicated that during the time of the campaign the call center had an increased number of phone calls. Although there was an increase in phone calls, there was no way of determining if this was a result of the campaign.
Both campaigns showed initiative in the prevention of suicide. However, the question remains, can more be done? I am disappointed with the social media campaign. The campaign lasted for one month, without any mention of the results. The initiative was taken to look up social media accounts, and current posts are next-to-none, the Facebook account of 22to0 posts an average of once per month. Needless to say, this is inadequate for sharing information on the prevention of suicide. It seems that the campaign needed an administrator who was devoted to making the campaign a long term success.
In the Ohio campaign, although the suicide hotline received an increase in phone calls, it is unclear as to how many phone calls resulted from advertising. It seems callers could have been asked questions during the initial phone call as a means for determining effectiveness. A second downfall is that no data from surrounding areas was available for comparison.
It is a Permanent Solution to a Temporary Problem
As I reflect on a proposed policy to improve my chosen population, my campaign would read, It’s a Permanent Solution to a Temporary Problem. When developing a campaign, it is vital that ideas are thought out, and a plan put in place, to bring it to fruition.
The first consideration is funding. How will I raise funds to promote my campaign? According to Knickman and Kovner (2015), it is important to involve multiple businesses’ to assist in furthering the campaign (p,134). First, preparing a proposal for local businesses, hospitals, schools, and churches are vital. The goal of a proposal is to get others involved either through financing, volunteering, or simply sharing information. I believe that the combination of social media and a suicide call center will make an excellent source of advertisement and resources. Once there are finances established, advertising needs to begin. I immediately think of videos that go viral on Facebook. Perhaps creating a mini story of a suicidal attempt story, will help draw the attention of social media. Encouraging social media users to share the story, may help others who are suicidal. Once establishing a campaign, it needs to continue for longer than just a few months. The comparing of data from other nearby suicide call centers, recording the source of the referrals, and tracking the suicide rate before, during, and after the campaign is necessary to prove a success. If the campaign is proven successful, all efforts should be made to continue.
Advocating for Veterans
Suicide among the veterans is an aspect of concern that is affecting families and loved ones. The increasing number of suicides requires the implementation of sound policies geared towards its prevention. Therefore, the advocacy that focuses on awareness and public involvement towards maintaining an enabling environment for veterans should be a step forward in reducing suicides. Therefore, this paper will examine the advocacy as per the case questions.
Policy
Modification of the National Defense Authorization Act of 2010 is a viable approach towards encompassing the proposed policy. The Act emphasizes on the idea that it is mandatory for trained individuals to conduct post-deployment health evaluation (Bullman, et al., 2015). As a proposed policy focused towards community awareness and involvement in the reduction of suicide rates, the use of the Act will require additional stipulations on veteran suicide rates. Hence, additional to the Act should denote focusing on:
• Additional funding to call centers for more staff for regular communication with the veterans
• Mandatory policy for organizations to set aside job positions for veterans
• Federal funding for the counseling programs available for veterans
• Regular visitation of the veterans by social workers and counselors
Advocacy Efforts
The Freedom of Information Act part B5 may pose a daunting prospect in the advocacy efforts. In reference to McCarten, et al., (2015), the part emphasizes on the notion that Army officers should not reveal secretive information on their acts under combat. As an advocacy effort that focuses on generating awareness on the causes of suicide and measures to reduce suicide by the veterans, information revelation by the veterans will be in a minimal manner. The majority of the veterans may be unwilling to reveal the details of the mission that they undertook that led to their trauma.
On the other hand, Privacy Act of 1974 may impede on the advocacy efforts (Maynard & Boyko, 2015). Maintaining contact with the military veterans is dependent on having access to their personal information. Without their consent, it should constitute as privacy infringement that is illegal as per the Act. Further, maintaining regular calls should be as a result of informed consent by the veterans or it will constitute a privacy infringement.
Methods to Influence Legislators
Advocacy for the policy will depend on the three-legged stool approach. To ensure effectiveness, the use of the Capitol leg, community/grassroots, and the media leg will require successful advocacy. Therefore, like the first, the Capitol leg will denote focusing on the legislative representatives. The lobbying approach will entail communicating with the local representatives through face-to-face meetings and presentation of the written proposal of the policy will articulate the seriousness of the suicide issue among the veterans. On the other hand, community or grassroots advocacy will entail communicating with families directly affected because of their veteran family members who committed suicide. Through close communication with families affected, the formation of lobby groups, peaceful demonstrations towards spreading the word on suicide is bound to prevail (Kang, et al., 2015). As such, the use of families directly affected by the loss of their veteran family member to suicide will generate awareness on the issue and generate public sensitivity to the veteran suicide (Bryan, et al., 2015). Lastly, the media leg will play a pivotal role towards generating a wider form of awareness of veteran suicide. The prospect of 8000 veterans committing suicide annually requires public awareness. Hence, the use of social media and television will generate a wider scope of outreach on veteran suicide. The use of Facebook, Twitter, and Instagram to generate pages of individuals grappling with the suicide of their veteran loved ones is an effective approach to reach out on the need for implementing the policy. Further, televised interviews on the topic of veteran suicide are essential considering the high number of individuals that watch television. The use of known news channels such as Fox and CNN news will ensure mass reach on the suicide issue.
Obstacles
The legislative process may be faced by non-involvement of the veterans. As the subject of interest in the lobbying process, a majority of the veterans are ashamed to talk about suicide or mental illness; and how it affects them. Most importantly, veterans are afraid to open up due to reprimand coming from their peers the administration. Therefore, the non-involvement of the veterans in the lobbying process can be handled through the involvement of the families of the veterans. As such, the involvement of the families in the lobbying process can present a firsthand account on the day-to-day life that the relatives have to go through. Further, to involve the veterans, proposing censoring their faces, names and voices in the television interview process is a viable move to generate awareness on the mental health problems they face in their day-to-day lives (Bryan, et al., 2015). Most importantly, generating information on the shortfalls of the Post Traumatic Stress Disorder treatment should generate information on the changes that need to be undertaken.
Suicide among veterans requires combined efforts. The involvement of both individuals and organizations in tackling the issue is an important approach to require collaboration and generation of an effective policy. Despite the obvious challenges for the implementation of the policy, the use of the lobbying tools and involvement of the families affected should present awareness on the veteran suicide problem.
Potential Ethical Dilemma.
There is absolutely no doubt the significance of health advocacy and promotion programs. Public awareness about potential risks about certain health risks and vulnerability is absolutely unchallenged, yet there often occur some fundamental questions that arise during the process which raises a lot of question. The issues that occurs as a result of the advocacy campaign provides potential health dilemma. In this case; a possible ethical dilemma that is worth considering is, the extent to which the advocacy should go, in attempt to present positive health information; (sometimes even moralizing) the information in bid to protect the public health without necessarily stigmatizing people or making those who have already attempted or contemplated suicide feel more guilty. Masse and Williams (2012) reports that, stigmatization during public health awareness is such a common occurrence, and sometimes ends up affecting the very purpose that the campaign was meant to serve. It is therefore important to always consider the potential ethical considerations that may arise during a public health advocacy and develop strategies of navigating around it.
In order to overcome this ethical dilemma, provision 7 of the American Nursing Association (ANA) is invoked. The provision states that, “the nurses in all roles and setting advances the nursing profession through research and scholarly inquiry, professional standards development and, the generation of both nursing and health policy” through this provision, the advocacy has the responsibility of conducting and establishing first the impact that the advocacy campaign may have on stigmatization as far as suicide is concerned. Past research programs can be evaluated in relation to this campaign, draw lessons and improve the advocacy. It all depends with how the information is provided in the first place. Indeed suicide is an evil act in the society and is always condemned. However, better and friendly ways can be developed through which the intended information about the ills of the act are communicated; the information delivery should not leave those who have at one time attempted the act feel even more guilty. Instead it should provide hope.
Another potential ethical dilemma is the impact that the common goal of advocacy campaign about suicide is likely to have on the autonomy of the cultural minority. It is a fact that in some cultures, suicide is considered evil and is often not talked about openly. Some cultures even practice rituals in the event of suicide occurrence. Therefore to talk about suicide in public, to expect such members of the community to actively and voluntarily participate in the campaign would be a little complicated, yet the success of the program depends on community members’ participation and cooperation.
Ethics and lobbying laws
Essentially, provision 7, 8 and 9 of the ANA code of ethics are applicable to this advocacy campaign. Provision 7 has already been stated in the immediate section above. Provision 8 stipulates that “the nurse collaborates with other profession and public to protect human rights to promote health diplomacy and, reduce health disparities. Provision 7 provides the basis upon which the very advocacy is built, the responsibility of the nurse to conduct research and scholarly inquiry in order to advance the nursing profession”. Provision 8 in this respect provides the basis upon which collaboration and cooperation with the public and other professionals is established as part of the program. Considering the potential health dilemma of lack of cooperation from certain members of the public, potential conflicts and friction may arise, especially from the opponents of public campaign on suicide health issues. Since everyone is protected by the laws of fundamental human rights, the opponents have the liberty of taking legal actions on the campaign on grounds of infringement on their rights. As a result, collaboration with other professionals such as lawyers are provided in provision 8 to mitigate such potential ethical dilemma may be fundamental.
Section 102.08 of the Ohio state shall be applicable in case of conflict among the lobbying agency and the community. The law provides that “the board of commissioners or grievances and discipline of the supreme court, and the joint legislative ethics committee may recommend legislation relating to ethics, conflict of interest and financial disclosure…” (The Ohio Ethics Commission, 2016). Conflict of interest in this campaign is most likely given the divergent cultural opinion regarding suicide.
Special Ethical Challenges
The special ethical challenge that is likely to face the program is essentially the cultural diversity and divergent opinion. Within the community, there are different communities, especially the minority. It is important to reach out to such minority in the community. The problem however is reaching them. Most of such members are never confident to talk about suicide. It would therefore be such a great challenge to diverse a strategy on how to maneuver this issue. The matter is further complicated by the fact that, members of such families who may be vulnerable to suicidal acts are often barred from participating in such programs. Other families would simply not participate in the program not because of cultural stigmatization about suicide but due to pride, prestige and family status. Feigelman & Jordan (2009) reported that most high status families are less likely to report about suicide acts in their families than those in less privileged families. Grad et al (2004) reported that some at least 3 out of 10 suicide cases are often misreported. Some families would rather provide a different cause of death than suicide. Yet such families are the ones whom the program really needs to reach out to and perhaps change the perspective, it is indeed an unfortunate situation.
Summary
Suicide is a problem that affects people regardless of age, race, income levels or ethnicities. In the United States, it is the 10th leading cause of death. Depression, physical or emotional abuse, bullying, financial stress and pressure from peers are the fundamental factors that are associated with suicide. Fortunately, suicide can easily be prevented as long as the right interventions are established in time. Among such strategies include advocacy campaign.
Advocacy campaign is one of the most popular public health awareness methods that are available today. It basically targets the members of the community through educative forums. The information about the campaign is often provided through different channels, could be through the social media, print and press media. The main aim is to get the public aware of a potential health risks and vulnerability. The campaign is however guided by professional code of ethics and legislative laws. Among the important code of ethics used commonly in public health advocacy programs are provided in the ANA code of ethics. In particular provision 7, 8 and 9 are the most fundamental ones. The campaign was guided by section 102.08 of the Ohio State Ethics Law and related Statutes. The provisions and the laws are important to mitigate the potential ethical dilemmas that arose during the advocacy campaign
References
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Bullman, T., Hoffmire, C., Schneiderman, A., & Bossarte, R. (2015). Time-Dependent Gender Differences in Suicide Risk among Operation Enduring Freedom and Operation Iraqi Freedom Veterans. Annals of Epidemiology, 25(12), 964-965.
Feigelman, W., Gorman, B. S., & Jordan, J. R. (2009). Stigmatization and suicide bereavement. Death Studies, 33(7), 591-608.
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Kang, H. K., Bullman, T. A., Smolenski, D. J., Skopp, N. A., Gahm, G. A., & Reger, M. A. (2015). Suicide Risk among 1.3 Million Veterans Who Were On Active Duty during the Iraq and Afghanistan Wars. Annals of Epidemiology, 25(2), 96-100.
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Maynard, C., & Boyko, E. J. (2015). Datapoints: Suicide Rates in the Washington State Veteran Population. Psychiatric Services.
Mccarten, J. M., Hoffmire, C. A., & Bossarte, R. M. (2015). Changes in Overall and Firearm Veteran Suicide Rates by Gender, 2001–2010. American Journal of Preventive Medicine, 48(3), 360-364.
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Oliver, R., Spilsbury, J., Osiecki, S., Denihan, W., Zureick, J., & Friedman, S. (2008). Brief report: preliminary results of a suicide awareness mass media campaign in Cuyahoga County, Ohio. Suicide & Life-Threatening Behavior, 38(2), 245-249.
The Ohio State Ethics Commission (2016). Ohio Ethics Law and Related Statutes. Ohio State Ethics Commission.