Positive Approaches Journal, Volume 13, Issue 4

Volume 13 ► Issue 4 ► March 2025

The Intersection of Mental and Physical Health Impacting our Communities:

Part 1

Everyone has a right to an everyday life that includes being as healthy as possible both mentally and physically. Participating in and having the best possible everyday life can be challenging for individuals with an intellectual disability and/or autism (ID/A), especially if they have both physical and mental health needs. These individuals may need specific support and treatment to ensure they can achieve their best possible everyday life. In collaboration with the Information Sharing and Advisory Committee (ISAC), a list of 12 recommendations were developed to support individuals with ID/A in achieving their best possible everyday life. Recommendation five (5) is to promote health, wellness, and safety. Recommendation six (6) is to support people with complex needs. Representing resources from both the Office of Developmental Programs (ODP) and the Office of Mental Health and Substance Abuse Services (OMHSAS), the next two issues of the Positive Approaches Journal are devoted to the discussion of topics related to challenges around maintaining and supporting both physical and mental health and to provide information on resources.  

In this first issue we will discuss the shortage of both primary health and mental health care professionals. We will also discuss the five primary health conditions that can significantly elevate the risk of severe illness and death in individuals with ID/A, supporting nutritional needs of individuals with autism, utilizing a public health approach to address wellness for individuals who have encountered trauma, and supporting individuals and their families who have survived suicide.

Volume 13 ► Issue 4 ► March 2025

Data Discoveries

The goal of Data Discoveries is to present useful data using new methods and platforms that can be customized.

Health Professional Shortage Areas in Pennsylvania

The need for health care services in the United States has increased significantly in recent years as the population ages and grows, and there is some evidence suggesting that this need will soon outpace provider availability, exacerbating disparities in access to care. The National Center for Health Workforce Analysis projects that the United States will experience a total shortage of 187,130 full-time equivalent physicians in 2037, and 31 out of 35 specialties are expected to encounter shortages.1 Family Medicine is projected to experience a significant shortage, meeting only 73% of the projected need for services; similarly, General Internal Medicine is projected to meet 76% of that need. This could mean that about a quarter of those who need primary health care services will not be able to access them. 

The United States is also facing a mental health crisis with increasing unmet behavioral health needs across people of all ages. Behavioral health services can be difficult to access due to high costs, coverage gaps, and provider shortages.2 Currently, over one-third of the U.S. population lives in a Mental HealthCare Health Professional Shortage Area (HPSA), and substantial behavioral health worker shortages are projected in the future.2 Rural counties are often at greater risk for provider shortages compared to metro areas, further exacerbating unmet needs and access to services.1,2

People with intellectual and developmental disabilities (IDD), including those with autism and intellectual disabilities, often have multiple physical health and mental health needs,3 and experience higher rates of co-occurring mental health conditions compared to their peers without IDD.4  Autistic people are more likely to have unmet health care needs, experience challenges accessing treatment or counseling, and encounter higher health care costs compared to non-autistic people.3 Living in an HPSA may further increase risk for poor health and mental health outcomes among people with IDD, underscoring the importance of examining the percentage of this population who may be at risk for limitations in access to health care services due to a shortage of providers. Autistic Pennsylvanians of all ages and their families have reported difficulties finding needed services.5 Pennsylvania Autism Needs Assessment (PANA) data suggest that the most common barrier to accessing care is a lack of providers, and parents have reported no or few providers for specific needed services.5 This lack of provider access was reported to be worse in rural areas and for adult services.6 

The dashboard below displays the percentage of Pennsylvanians with and without IDD who live in Health Professional Shortage Areas. The Health Resources and Service Administration (HRSA) defines HPSAs as geographic areas, populations, and/or facilities that have a shortage of primary, dental, and/or mental health care providers. The dashboard focuses on geographic HPSAs, which are areas in which the entire population experiences the shortage and reflects the percentage of Pennsylvania Medicaid enrollees whose zip codes fall into geographic HRSA-defined HPSAs. The data can be filtered by important demographic characteristics, including age group, insurance, race/ethnicity, and gender. To provide national context and relevant comparison data for Pennsylvania, dashboard users may also view the percentage of those living in HPSA in New York, North Carolina, and Ohio. These states were selected as useful points of comparison due to their similarities in population, population density, median income, unemployment rates, and or geographic proximity. 

These data suggest that overall, a greater percentage of Medicaid enrollees in Pennsylvania live in a mental health professional shortage area compared to a primary care professional shortage area. This pattern is observed across most of the other states included in this dashboard. Across all age groups, a higher percentage of Pennsylvanians with IDD live in a mental health professional shortage area compared to people without IDD. Notably, however, we observe the greatest disparity between those with and without IDD in the 18–21-year-old age range, with 14% of those with IDD living in a mental health professional shortage area compared to 11% of those without IDD. 

The proportion of Medicaid enrollees with IDD who live in either a primary care or mental health professional shortage area also increases with age: 12% of Medicaid enrollees with IDD aged 1-17 live in HPSAs compared to 16% of those with IDD aged 40-64. Disparities are also observed across race/ethnicity and disability status: in Pennsylvania, 3.6% of Black people with IDD live in HPSAs compared to 3.1% of Black people without IDD. These differences are similar across the other states included in this dashboard.  

These findings highlight the importance of increasing access to primary care and mental health professionals for people with disabilities. This includes not only increasing the number of providers available in each area, but also improving knowledge and awareness of IDD among those providers to best support people in need of these services. Provider incentives, including those to encourage telehealth offerings, may support increased access, especially for people who live in rural areas. As the need for both physical health and mental health services persists, it is critical to continue monitoring how these shortages impact people with IDD in Pennsylvania.

Volume 13 ► Issue 4 ►March 2025

Applying Public Health Principles to Health Psychology

Kate Fox, DrPH (c), MPH

Introduction

Health psychology refers to a field of study that examines how psychological factors influence health and illness, including thoughts, emotions, and actions¹. Framing health and wellness as an individual responsibility overlooks the broader systemic and social drivers that shape health and mental health outcomes. A public health approach to psychological and mental health is desperately needed. Public health principles emphasize population-level interventions and structural changes, offering valuable insights to improve health and wellness. This article explores how systemic factors influence mental health and discusses public health policy solutions aimed at addressing systemic trauma to promote population wellness.

Systemic and Social Drivers of Mental Health

In the latter half of the twentieth century, mental health as a field has made significant advances in scientific understanding of mental disorders, focusing primarily on disease pathways such as neurotransmitters and hormones (e.g. serotonin, dopamine). The advent of pharmacological options to treat mental illness such as depression, anxiety, bipolar disorder, and schizophrenia marked a significant transition in the field to psychopharmacology, neurological approaches, and the pathologization of mental illness. As recently as 1977, 64% of psychiatric visits were exclusively for psychotherapy without an accompanying prescribed medication; in 2002, this was true for less than 10% of psychiatric visits². 

Despite these scientific advancements, the population’s mental health has continued to decline. The number of people receiving mental health treatment has increased by 15 million people since 2002 ³. One in eight U.S. adults is currently taking an antidepressant ⁴. The COVID-19 pandemic ignited national conversation about mental health, with the Surgeon General issuing a warning around youth mental health and workplace mental health in 2021 and 2022 respectively^5,6. 

Despite significant shifts in the scientific knowledge base underpinning the mental health field, America's mental health crisis has only worsened. Almost a third of United States (U.S.) adults report symptoms of depression or anxiety, which is three times higher than those reporting symptoms in 2019⁷. In 2022, only 31% of U.S. adults considered their mental health “excellent,” a decrease of 43% from the same report in 2002⁸. In 2022, the Centers for Disease Control and Prevention (CDC) recorded the highest rate of suicides in the nation’s history, an increase of over 30% since 2000⁹. While efforts to increase access to evidence-based treatments, therapeutic interventions, and tech-based solutions have advanced, the field is falling short in addressing the mental health needs of the population.

This is where public health comes in. To date, approaches to solving the mental health crisis have been targeted primarily at the individual level, adhering to the traditional medical model of diagnosing and treating illness. A public health approach focuses on preventing disease among a whole population by addressing risk factors at the community level. 

Consider the single mother I interviewed living in Delaware County, PA. She has a full-time job, a part-time job, and is raising a daughter with significant mental health challenges. Despite recognizing the importance of mental health and self-care, she has neither the time nor the resources to engage in wellness activities such as therapy, exercise, or even regular medical check-ups. The expectation that she should just “manage stress better” or “take a bubble bath” disregards the systemic factors that create and sustain these conditions. Instead of placing the burden of wellness solely on the individual, policies should focus on systemic reforms that alleviate these pressures.

Lack of Preventative Care in Mental Health

Public health has made significant advancements in the physical health care system that have yet to be made in mental health care. In primary care, individuals can seek treatment for minor ailments like colds or infections without requiring a formal diagnosis. Preventative measures such as vaccinations, routine screenings, and general wellness check-ups serve as the first line of defense against more severe illnesses. These proactive interventions reduce the burden on emergency services and improve long-term health outcomes.

Mental health care, however, lacks the equivalent first line of defense. Access to mental health care typically requires a formal diagnosis, insurance approvals, and other barriers that make early intervention difficult. Instead of a system designed to provide proactive support, mental health services are typically responsive – only available once symptoms become severe enough to warrant intervention. This gap in early access causes worsened health outcomes and places unnecessary strain on an already overburdened crisis system.

By applying a public health approach to mental health care, preventative care could be expanded, mirroring successful strategies in primary care. Community-based mental wellness programs, workplace mental health screenings, and school-based access to counseling could build a preventive care system to address mental health challenges before they escalate. Just as vaccines help prevent illness in physical health, mental health interventions can serve as population-level protective factors against more severe mental health conditions.

Policy Solutions for Systemic Change 

To move beyond the traditional individual-centered approach to mental health, policymakers and public health professionals must implement strategic, systemic interventions that address the root causes of poor mental health. Key strategies include:

For a detailed analysis of policy recommendations for Pennsylvania’s Medicaid HealthChoices program, please see the Children First report Optimizing Medicaid to Improve Child and Youth Mental Health in Pennsylvania.

Conclusion

Public health principles offer a critical framework for addressing mental health and well-being at a systemic level. Rather than placing the responsibility for well-being solely on an individual, a population-level approach recognizes the role of social and systemic drivers in shaping health outcomes. By implementing policies that address economic stress, expand community-based solutions, and integrate trauma-informed practices, we can create healthy environments that support long-term wellness for all. Health psychology must evolve beyond personal responsibility narratives and embrace systemic change as a necessary foundation to promote population health.

References

1.     Hariharan M. The Textbook of Health Psychology. 1st ed. Routledge; 2024. doi:10.4324/9781003438908.

2.     Mojtabai R, Olfson M. National Trends in Psychotherapy by Office-Based Psychiatrists. Arch Gen Psychiatry. 2008;65(8):962-970. doi:10.1001/archpsyc.65.8.962.

3.     Mental health treatment or therapy among American adults 2002-2021. Statista. Accessed January 14, 2024. Number of U.S. Adults who Received Mental Health Treatment or Counseling in the Past Year from 2002 to 2023.

4.     Products - Data Briefs - Number 377 - September 2020. September 8, 2020. Accessed January 14, 2024. Antidepressant Use Among Adults: United States, 2015-2018.

5.     Office of the Surgeon General (OSG). Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory. U.S. Department of Health and Human Services; 2021. Accessed January 14, 2024. Protecting Youth Mental Health.

6.     Surgeon General. Workplace Mental Health and Well-being. U.S. Surgeon General; 2022.

7.     Mental Health - Household Pulse Survey - COVID-19. November 6, 2023. Accessed January 14, 2024. National Center for Health Statistics - Anxiety and Depression.

8.     Inc G. Americans’ Reported Mental Health at New Low; More Seek Help. Gallup.com. December 21, 2022. Accessed January 14, 2024. Americans' Reported Mental Health at New Low; More Seek Help.

9.     CDC. Underlying Cause of Death, 2018-2021. CDC WONDER Database. 2021 2018. Accessed January 14, 2024. The Underlying Cause of Death Database.

Volume 13 ► Issue 4 ► March 2025

Cooking with Confidence for Autistic Individuals

Mi-Yeet Wong

What if we reimagine our approach to whole health? Instead of addressing isolated aspects of a person’s life, we could take a more holistic view—one that considers the interconnected factors shaping their well-being. Take cooking, for example. Rather than simply teaching people how to prepare meals, we could explore their first experiences with cooking, their access to ingredients, the foods they enjoy, and how often they share meals with others. From an educational standpoint, how can we equip individuals to assess a food’s nutritional value in a way that aligns with their unique health needs? And from a systems perspective, how can we leverage existing resources to create sustainable opportunities that foster long-term well-being? These are all questions we have explored in our community-based program Cooking with Confidence for Autistic Individuals. This article will share insights from the program, highlight existing initiatives and resources, and discuss opportunities for future development.

Philosophy

Cooking with Confidence for Autistic Individuals is grounded in multiple conceptual frameworks and philosophies that shape its purpose, reach, and implementation. These approaches include Food is Medicine,² the belief that community is intervention, the Living an Everyday Life framework,¹ and a commitment to program implementation through a health equity lens.³

With these guiding principles in mind, Cooking with Confidence for Autistic Individuals provides hands-on cooking experiences that bridge physical health with mental well-being, fostering skills, connection, and empowerment.

 Program Background

Leveraging Partnerships

The partnership between the Philadelphia Autism Project and the Free Library of Philadelphia began with the development of Sensory Storytimes—special library sessions that provided extended hours exclusively for families of children on the spectrum, creating an inclusive and judgment-free storytelling experience. Building on this collaboration, the Philadelphia Autism Project recognized an opportunity to expand inclusion beyond storytelling and into the kitchen. When they learned about the mission and programming of the Free Library’s Culinary Literacy Center (CLC), ⁶ they saw cooking as a powerful tool for engagement and learning. Founded in 2014, the CLC promotes literacy through cooking, integrating math, reading, and science into hands-on learning experiences. By exploring new foods, tools, and techniques, participants of all ages gain both culinary and educational skills. Committed to accessibility and inclusion, the CLC offers a range of programs, including Cooking with Confidence Program for Autistic Individuals, designed for individuals on the spectrum.

Planning for the Cooking with Confidence Program for Autistic Individuals began in 2017 with support from a university seed grant aimed at driving innovative projects. Following this initial funding, the Philadelphia Autism Project contributed funds, complemented by a matching grant from the Free Library of Philadelphia Foundation. By leveraging existing city-funded resources and forging innovative partnerships with an interdisciplinary team—including the CLC, AJ Drexel Autism Institute (an autism research center operating within a university), Drexel Food Lab (connected with a university College of Nursing and Health Professions), and National Institutes of Health Clinical Center (a national center focused on diseases, illnesses, and related solutions) - the program has expanded to incorporate nutrition analysis, an evaluation component, and additional recipes. When exploring funding opportunities, tapping into local city-funded or university resources can be a powerful catalyst for launching new programs.

Program Components

The Cooking with Confidence Program for Autistic Individuals is a community-based educational program where autistic individuals practice independent living skills, health promotion activities, and participate in social and community engagement through hands-on cooking classes. As the program is implemented in an urban city where there are high poverty rates⁷ and food insecurity,^8-9 the development of this program considered accessibility and affordability. Recipes were chosen based on affordability and in alignment with SNAP benefits.¹⁰ The program was offered at no cost to participants, and if transportation challenges arose, program coordinators offered additional funding to secure transportation. Accessibility was considered throughout the program development and implementation - from recipe selection and the strategic breakdown of tasks to the registration process and communication on accommodations needed.¹¹

Through hands-on classes, participants practice essential skills such as reading recipes, practicing basic cooking techniques, and maintaining kitchen safety. They prepare a plant-based meal and gather around a communal table, where they explore and discuss unfamiliar foods in a supportive social setting. Participants bring a diverse range of experiences, enriching the learning environment. Beyond nutrition and cooking, they engage in conversations about stepping outside their comfort zones, encouraged by their peers. While these moments may seem small, they hold significant value. For individuals who thrive on consistency and routine—whether in their schedules, environments, or diets—trying something new can expand their own perceptions, as well as those of their support network, about what is possible. Program staff can pair this opportunity with connecting participants to resources, such as supporting participants in applying for a Free Library card, the use of travel training to commute to the library or sharing autism-related resources.

Resources, Research and Policy

While the Cooking with Confidence Program for Autistic Individuals serves as a promising model for future expansion, many other valuable culinary programs and resources also deserve recognition. Below is a selection of resources, though it is not an exhaustive list.

Future Direction

There are numerous opportunities to expand the Cooking with Confidence Program for Autistic Individuals. Potential next steps include developing a curriculum based on key learnings to support program replication in new settings, integrating a nutritionist-led lesson plan to educate participants during sessions, and further exploring the connection between food selectivity and autism to inform recipe selection. By building on these foundations, the program can continue to empower individuals, foster inclusion, and enhance well-being across diverse communities.

References 

1.     LifeCourse Nexus. LifeCourse Framework. 2024. Accessed February 10, 2025. LifeCourse Framework.

2.     Volpp KG, Berkowitz SA, Sharma SV, et al. Food Is Medicine: A Presidential Advisory from the American Heart Association. Circulation. 2023;148(18):1417-1439. Food Is Medicine.

3.     Kerkhoff AD, Farrand E, Marquez C, Cattamanchi A, Handley MA. Addressing health disparities through implementation science—a need to integrate an equity lens from the outset. Implementation Science. 2022;17(13). Addressing Health Disparities Through Implementation Science.

4.     Grace K, Reminton A, Brynmor L, et al. Loneliness in autistic adults: A systematic review. Autism. 2022;26(8):2117-2135. Loneliness in Autistic Adults: A systematic Review.

5.     Orsmond GI, Shattuck PT, Cooper BP, Sterzing PR, Anderson KA. Social participation among young adults with an autism spectrum disorder. J Autism Dev Disord. 2013;43(11):2710-2719. doi:10.1007/s10803-013-1833-8.

6.     Free Library of Philadelphia. Culinary Literacy Center. 2025. Accessed February 10, 2025. Culinary Literacy Center.

7.     The Pew Charitable Trusts. Philadelphia 2024 The state of the city. Published April 11, 2024. Accessed February 10, 2025. Philadelphia 2024.

8.     Inguito K, Joa B, Gardner J, Fung EN, Layer L, Fritz K. Differentials and predictors of food insecurity among Federally Qualified Health Center target populations in Philadelphia: A cross-sectional study. BMC Public Health. 2023;23(1323). Differentials and Predictors of Food Insecurity Among Federally Qualified Health Center Target Populations in Philadelphia.

9.     Center for Hunger Free Communities. Changing the Narrative to Change the Policy. Ending Hunger in America. Food insecurity solutions based on lived experience. 2022. Accessed on February 10, 2025. Ending Hunger in America.

10.  Brown L. Good and Cheap: Eat Well on $4/Day. Workman Publishing; 2015.

11.  Wong M, Rietzen C, Fitzgerald E, Richardson C, Uppal D, Shea L. Cooking with confidence: partnering to support teenagers and young adults on the autism spectrum. Public Libraries. 2020;59(4):32. Cooking with Confidence.

Biographies

Mi-Yeet Wong uses her prior experience as a Case Manager for adults with developmental differences to contribute to her current work in supporting individuals, their family members, and the community through program development and resource navigation. She connects with autistic individuals and their families through the statewide resource center “warmline,” develops resources informed by community feedback, and embeds community-informed infrastructure across projects.

 

Contact Information

Volume 13 ► Issue 4 ► March 2025

The Fatal Five and the Importance of Monitoring

Jenifer Baker RN, CDDN, CDP

The "Fatal Five" refers to the five primary conditions that significantly elevate the risk of mortality in individuals with intellectual and developmental disabilities (IDD). These conditions include aspiration, seizures, constipation, dehydration, and infection/sepsis. Notably, many of these conditions are often preventable. However, they may frequently go unrecognized, be misdiagnosed, or be mistaken for behavioral expressions. By promoting education and increasing awareness within family members, support persons, and the individuals themselves, regarding the significance of monitoring, documenting, and reporting these conditions to health care professionals, it is possible to help to reduce the risk of fatalities associated with these conditions.

Aspiration refers to the process in which foreign objects such as food, liquids, medications, or even a person’s own secretions, are inhaled into the lungs. It can lead to respiratory infections that can be serious and life-threatening such as pneumonia. There can be obvious signs that someone has aspirated, but there can also be subtle signs. It can be especially difficult if the person is unable to communicate that they have had difficulty swallowing or have had choking episodes. Signs that may indicate a person has aspirated can include:

Individuals with IDD may experience an elevated risk of aspiration due to conditions such as seizure disorders, cerebral palsy, and dysphagia. Additionally, certain medications can further increase this risk by impairing alertness. Particularly, anticholinergics such as diphenhydramine (Benadryl), commonly used to relieve allergy symptoms; oxybutynin (Ditropan) and tolterodine (Detrol), both used to treat symptoms of overactive bladder; and benztropine (Cogentin), prescribed to treat Parkinson’s disease and medication-induced movement disorders. Certain psychotropics and muscle relaxants can also contribute to decreased awareness. Should the individual have a meal plan in place which modifies the consistency of foods and liquids, it is imperative that this plan is strictly followed. Vigilant monitoring for signs of aspiration, along with ensuring appropriate seating and positioning during meals is essential. Should any indicators of aspiration or respiratory infections arise, it is crucial to consult a medical provider for prompt evaluation.

Seizures are abnormal electrical responses in the brain which may result in involuntary physical and behavioral changes. There are several different types of seizures. Some may be obvious, such as with a tonic-clonic (formerly known as grand mal) seizure, or the seizure may be so subtle that it goes unnoticed, such as with an absence seizure (staring seizures), certain focal seizures (complex partial seizures), and even atonic seizures (drop seizures). The understanding that seizures will vary and look different for each person is important when monitoring for signs.

Below are signs that might be seen when a person has a seizure.

For some individuals, these signs may be mistaken for unprovoked behavioral outbursts. This can lead to misdiagnosis. When the seizure does occur, note the time the active seizure started and stopped and what was observed before, during, and after. It is also helpful to ask the person if they can provide any insight into what they have experienced or felt before, during, or after the seizure. Documenting known seizure triggers can also be insightful when supporting and monitoring someone who has seizures. Always clear the area for the person who is having the seizure, keep them safe, and never place anything in their mouth. Call 911 if it is their first seizure ever, it lasts longer than five minutes, they are having back-to-back seizures with no return to baseline, they have trouble breathing, do not regain consciousness after the seizure, or if they have sustained an injury that requires more than basic first aid.

Constipation occurs when a person has infrequent, difficult, or painful bowel movements. This can become life threatening as it can lead to bowel obstruction. For people with IDD, constipation is a common condition. Keeping a bowel chart can help with monitoring bowel habits and it may also be useful to implement a toileting schedule to help the person follow a bowel routine. Signs of constipation could include:

There are conditions that can also increase the risk of constipation, including neurological disorders, metabolic or endocrine disorders, gastrointestinal conditions, and aging. Reviewing a person’s diagnoses and history can be helpful. Several medications can have side effects of constipation. These are some of the more common ones:

Therefore, reviewing current medications to determine if they are a factor can give insight into potential causes. If there are concerns regarding medications that a person is taking, check the medication guides that come with the medications or speak with the pharmacist. For someone experiencing constipation it is important to monitor dietary fiber and fluid intake. If a person is not taking in enough fiber and liquid, this can contribute to constipation. Incorporating regular physical activity can also help with constipation. This can also be challenging if a person has mobility issues. If a person is experiencing frequent episodes of constipation speak to their medical provider for guidance on the best way to manage it.

Dehydration is a loss of more fluids than a person is taking in. For people with IDD there can be several barriers and challenges to ensuring they have adequate fluid intake. Some individuals with IDD are at greater risk for dehydration and it can happen quickly. It can happen even more so in hot weather, during illness, or if someone is physically exerting themselves. Signs that may be noted in someone experiencing dehydration can include:

Monitoring the color of someone’s urine is a good indicator of hydration. The darker and more concentrated the urine the less hydrated a person is. Also, monitoring fluid intake can give a better insight into how much fluid a person is taking in. Encouraging fluids frequently throughout the day, as well as foods that have higher water content, such as watermelon, strawberries, lettuce, cucumbers, popsicles, and flavored gelatin can aid in preventing dehydration. Water is always the best option. Avoid caffeinated and alcoholic beverages, like soda pop, which can contribute to dehydration.

Infection occurs when a pathogen, such as bacteria, viruses, parasites, or fungi, invade the body and multiply. Monitoring for signs of infection will depend upon what type of infection it is and the ability of the body to fight off the pathogen. A person may experience fever, chills, vomiting, diarrhea, coughing, redness, swelling, warmth, pus, or oozing from the affected area. For people with IDD there may be other signs that may be more difficult to correlate with an infection, such as behavioral changes including aggression, withdrawal, changes in mental status-confusion, delirium, or disorientation. They may be lethargic or unwilling to participate in desired activities or daily routines. If there is any type of pain, the person may be bracing, guarding, or rubbing the area of discomfort. For someone with dental pain they may refuse to eat. Sometimes the person just does not seem like themselves. It may be difficult to recognize that there is an infection occurring if there are not obvious outward signs. That is why monitoring, documenting, and making the medical provider aware of what is observed is essential, so that treatment of the infection is not delayed, and that it does not evolve into sepsis.

Sepsis is the body’s severe reaction to an infection, causing a cascade of events throughout the body. If not treated promptly, it can rapidly result in tissue damage, organ failure, and death. There are conditions that put people at risk for sepsis. It is more prominent in people over sixty-five, children under the age of one, people who have weakened immune systems, sepsis survivors, someone with a diagnosis of chronic health conditions, and medically fragile people with IDD.

Signs that may occur with sepsis can include:

Monitoring and reporting the signs of sepsis, as well as any of the other signs of infection will be important to promptly communicate to the medical provider. The provider should also be made aware of any prior known history of sepsis. This condition is severe and life threatening, requiring immediate evaluation and treatment.

It may not always be obvious that someone with IDD is experiencing one or more of the fatal five conditions. It is essential that those who are supporting the person, as well as the person themselves are educated and aware of what common signs and symptoms associated with the “Fatal Five" conditions—aspiration, dehydration, seizures, constipation, and infection/sepsis may look like. Monitoring, documenting, and communicating with all involved in care can help to ensure overall well-being for people with intellectual and developmental disabilities, reducing the risks associated with these fatal five conditions.

Volume 13 ► Issue 4 ► March 2025

Voices of Suicide

Heather McLean

Suicide is one of the leading causes of death locally, nationally, and internationally. Suicide rates have increased by 2.6% from 2021 to 2022. According to the Centers for Disease Control and Prevention (CDC)¹, 2022 statistics recorded the highest rates of suicides ever recorded in history. In 2022, 49,449 people died by suicide in the United States. On average, we lose 130 people to suicides every day in America. Suicide is the third leading cause of death for ages 10-24. Suicide has been referred to as the “silent epidemic” due to the stigma associated with suicide and mental health. The stigma with mental illness and suicide has created a barrier for people to reach out for help and to let others know they are struggling.

As a society, there was a time when we would only whisper the word cancer. The word cancer was associated with shame and embarrassment. When it comes to talking about cancer, we have come a long way in realizing we aren’t going to cause cancer or make it worse by talking about it. The pink ribbons have become synonymous with breast cancer, people raise lots of money for cancer research via social media and we openly discuss health habits and behaviors to try and prevent cancer. We should feel the same about suicide. Unfortunately, we have a long way to go with our comfort level in discussing and accepting mental health-related issues, especially suicide.

According to the CDC WONDER² report released in August of 2023, 12.3 million adults seriously thought about suicide, 3.5 million adults made a plan, and 1.7 million adults attempted suicide in 2021. Suicide rates among males continue to be four times higher than the rates among females. Males make up 50% of the population, but nearly 80% of the suicides. Firearms continue to be the most common method used in suicides. Nationally and locally, firearms are used in more than 50% of suicides according to the CDC and 2022 Westmoreland County Coroner’s Report.³

The aging population are at an exceptionally high risk of suicide. According to the 2022 Westmoreland County Coroner’s Report,³ suicides increased over 100% from 2021 to 2022 in the aging population. Some of the well-known risk factors in the aging population are the loss of a major relationship, particularly a spouse. Loss of mobility/loss of freedom due to loss of mobility and the onset of medical conditions or diagnosis of a terminal illness can be very big factors. The aging often feel that they have become a burden to others. Changes in medical conditions can be directly linked to depression. Often at a medical checkup, emotional issues are rarely addressed, leaving undiagnosed mental health concerns. Due to medical changes experienced by the aging, feelings of burdensomeness can put them at a very high risk for suicide.

The recent suicides over the last several years of some high-profile people like Robin Williams and Twitch have brought more attention to the suicide crisis in our country. According to the CDC², we are currently losing about 130 people to suicide every day. Even though people are talking more about suicide than ever, we still have a lot of work to do. Suicide continues to be a national health care epidemic across the lifespan.

What is left behind in the aftermath of a suicide is a trail of broken hearts filled with many unanswered questions. Loved ones that are left behind grieving are called suicide loss survivors. It is said that between 48 million and 50 million people are thought to experience suicide bereavement every year.⁴ A suicide loss survivor is at a four times higher risk of dying by suicide. It also increases the risk of depression and feelings of guilt, shame, and rejection. Suicide loss survivors are also at a greater risk for increased psychiatric needs and interpersonal disruptions and isolation. All these risks are higher in Suicide Loss Survivors than in any other traumatic kind of death.

The voices of suicide span across many facets of life. From the voice of the attempt survivor to the voice of a loss survivor. From a treatment perspective of the mental health provider to the professionals responding to suicide. They all have a voice. Are we listening? Attempt survivors and loss survivors are sharing their stories. They are writing books, doing podcasts, and using social media as a platform.

There is power in sharing your story. It is a framework centered through heartache and resilience. Mental Health Professionals are now listening to people with lived experience and finding great insight from the stories being shared. We are learning from every story to help prevent future suicides and to comfort the grieving. Coping with such a profound loss is unique to every person. Survivors of suicide are not alone in their grief. Ray of Hope, Westmoreland County Suicide Prevention and Awareness⁵ in partnership with Mental Health America of southwestern PA⁶ hosts a monthly support group called Loved Ones Stolen by Suicide (LOSS). This support group is facilitated by three long-term suicide loss survivors. The group allows for sharing, support, and encouragement for anyone who has experienced the profound grief of losing a loved one to suicide.

Ray of Hope also hosts a suicide attempt survivor’s support group called Hope and Healing, finding hope and support for those recovering from a suicide attempt. There are very few support groups for suicide attempt survivors. This is a safe place to talk openly about suicide. Being able to share your attempt story can bring a sense of relief. This group offers a way for people to express their feelings that suicidal thoughts exist. It is okay to have times where we feel overwhelmed, and that suicide may feel like the only way out. Sharing these feeling can open the conversation for people who are feeling alone and feel that no one understands. They realize they are not alone, and many people do relate to how they are feeling. This brings hope and connectedness. Connectedness is the biggest protective factor against suicide.

Suicide Awareness and Prevention Education for first responders, medical personnel, and mental health care providers needs to become a common thread of lifesaving measures intertwined in the trainings they receive. Only 10% of mental health professionals are competent to deal with a suicidal crisis, and those are the experts we go to in a crisis.⁷

Ray of Hope provides free suicide awareness and prevention trainings called QPR. QPR stands for Question, Persuade, and Refer. QPR is an internationally recognized evidence-based suicide awareness and prevention training for anyone⁸. These trainings are offered to anyone in Westmoreland County at no cost to the attendee. QPR teaches how to ask the suicide question, how to encourage/persuade someone to get help, and know where to refer a person to the needed resources. Using QPR can save a life. More information can be found at The QPR Institute.

The Ray of Hope, in partnership with the Westmoreland County Coroner’s Office³, has started a LOSS Team. Their mission is to make connections and instill hope in those grieving the suicide loss of a loved one by providing support, comfort, and needed resources. The team is made up of community members and suicide loss survivors trained to reach out to newly bereaved suicide loss survivors. This postvention response is also prevention for the newly bereaved loss survivors.

The LOSS Team model was developed by Dr. Frank Campbell at the Baton Rouge Crisis Trauma Center in 1998. The key to a LOSS Team is the connection made by a shared experience of a suicide loss. This creates an installation of hope, practical support, and connection to resources. The Ray of Hope, in partnership with the Westmoreland County BH/DS Office, invited Dr. Campbell to Westmoreland County in October of 2022 to provide a LOSS Teams training. That training began the journey to forming the county’s LOSS Team. Westmoreland County is the 2^nd county to have a LOSS Team in Pennsylvania.

The Ray of Hope looks for opportunities for people affected by suicide to share their stories. They held their annual conference November 17, 2023. The theme was “Sharing Saves Lives, The Power in Your Story.” The keynote speaker was an attempt survivor and published author who shared his story of hope and resilience. The afternoon consisted of an attempt survivor panel that shared their lived experiences through the journey of their suicide attempt and finding hope and connection.

Recently, the Westmoreland County Behavioral Health Disability Services Office received a grant from the Pennsylvania Department of Human Services Office of Mental Health and Substance Abuse to provide specialized trainings to mental health professionals to enhance efforts in managing suicide risk by partnering with other organizations and first responders. This training is called CAMS-care (Collaborative Assessment and Management of Suicidality)⁹. This training will allow Certified Suicide Prevention Specialists to respond to different levels of crisis response within the first responder system and greatly enhance our efforts to save lives. CAMS care is an evidence based, suicide focused treatment framework backed by 30 years of clinical research and six published randomized controlled trials. Giving providers tools to enhance their scope of practice is extremely important. This training will allow for 50 individuals in Westmoreland County to become Certified Suicide Prevention Specialists. Information can be found at CAMS Care.

In Westmoreland County, the voices of suicide are being heard. Through our awareness and prevention efforts, education, support groups, LOSS Team, and other community events, lives are being saved. Stories are being shared. People are getting connected and finding hope. The voices of suicide are many. Their stories are still being written.  

Westmoreland County has many resources to support our communities and those struggling with a mental health crisis. Westmoreland Community Action runs our local crisis hotline. The hotline answers calls 24 hours a day, seven days a week. They also have a mobile team that provides assessments based on the level of need of the caller. They can be reached by dialing 1-800-836-6010. A national resource is also available for immediate assistance. The 988 Suicide & Crisis Lifeline¹⁰ provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, seven days a week, across the United States and its territories. If you or anyone you know is in a mental health crisis or in need of emotional support, there are a lot of resources available. The Westmoreland County Behavioral Health Disability Services (BH/DS) Office has a list of local providers. They can be reached at (724) 830-3617 or on the Westmoreland County Website³. It is important to remember that there is hope, there is help, and you are not alone in your struggles.

References 

1.     Centers for Disease Control and Prevention. 2025. Centers for Disease Control and Prevention Website .

2.     Centers for Disease Control and Prevention WONDER Online Databases. 2025. Centers for Disease Control and Prevention WONDER Online Databases.

3.     Westmoreland County Coroner. Westmoreland County Website. 

4.     Pitman A, Osborn D, King M, Erlangsen A. Effects of suicide bereavement on mental health and suicide risk. Lancet Psychiatry. 2014 Jun;1(1):86-94. doi: 10.1016/S2215-0366(14)70224-X. Epub 2014 Jun 4. PMID: 26360405.

5.     Ray of Hope Westmoreland. 2024. Ray of Hope. 

6.     Mental Health America of Southwestern PA. 2020. Mental Health America of Southwestern PA.

7.     Aschwanden, C. Suicide attempt survivors seek a voice in helping others at risk. July 2014. Suicide Attempt Survivors Seek A Voice In Helping Others At Risk Article. 

8.     Question Persuade Refer Institute. The QPR Institute.

9.     The Collaborative Assessment and Management of Suicidality. 2025. The Collaborative Assessment and Management of Suicidality Framework. 

10.  988 Lifeline. 2025. 988 Lifeline Website.

Biographies

Heather Mclean began her career working in the mental health field 23+ years ago. Heather has been employed at MHA-SWPA since 2019 as their Outreach Coordinator. As part of her position as the Outreach Coordinator, Heather participates on numerous committees and boards. These committees include Ray of Hope Westmoreland County Suicide Awareness & Prevention Task force, CSAY-Counsel for Substance Abuse & Youth, HAWC-Hoarding Alliance of Westmorland County, and Steering Committee member for the Southwest Regional CIT Program. Heather currently holds an officer position on the state board of SPA-Suicide Prevention Alliance and on the Board and of Directors of Greater Things Ministries and Fight the Blight. Heather also works closely with the Westmoreland County BH/DS office coordinating lots of trainings and events. Heather has worked in suicide prevention since 2009. She has served as the Ray of Hope Chair since 2016. Her responsibilities include the oversight of 80+ task force members, multiple sub-committees, supervision of the task force coordinator, and Lead of the newly formed L.O.S.S. Team (Local Outreach to Suicide Survivors). Heather also facilitates the Hope & Healing support group for those recovering from a suicide attempt. Heather is the Westmorland County EBH (Emergency Behavioral Health) Coordinator that aids in the emotional response following a traumatic event. Heather is a certified QPR Gatekeeper Instructor, Certified CIT (Crisis Intervention Team) Coordinator, Certified YMHFA (Youth Mental Health First Aid) Instructor, Certified Bridges out of Poverty Instructor, and ASIST (Applied Suicide Intervention Skills Training) Trainer. Heather provides many trainings to schools, colleges/universities, community/social service agencies, businesses, medical personnel/first responders, and faith-based organizations. Heather is a 2002 honors graduate from Point Park University where she received her Bachelor of Science degree in criminology/criminal rehabilitation. Prior to that she attended Westmoreland Community College where she received an associate’s degree in legal assisting/paralegal in 2000. Heather likes to spend free time mentoring youth at The Father’s Heart Ministries. She also stays busy loving her two dogs, two children, and husband Troy.

 

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