Tompkins Coalition: “Yes” to Zero Suicide Model

The Tompkins County Suicide Prevention Coalition on Monday overwhelmingly voted to recommend the Zero Suicide Model for healthcare providers as a countywide suicide prevention initiative. Deputy Mental Health Services Commissioner Sharon MacDougall said the coalition’s recommendation will be sent to the Community Services Board and the Tompkins County Legislature for consideration.

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Deputy Tompkins County Mental Health Services Commissioner Sharon MacDougall (center) with Cornell University students Winnie Ho of Alpha Phi Omega Gamma Chapter and Sophie Jones of The Sophie Fund

Four healthcare organizations attending the meeting also announced their agreement to become Zero Suicide “champions”—Tompkins County Mental Health Services; Alcohol & Drug Council of Tompkins County; Cornell Health, the healthcare center of Cornell University; and Cayuga Area Plan/Preferred, Inc., which represents primary care providers. MacDougall asked the champions to “commit to the model and report back to this coalition next spring in 2019.” In March, the Cayuga Medical Center announced its adoption of the Zero Suicide Model.

Prior to the meeting, about 50 people attended a community presentation on the Zero Suicide Model given by Jillian King and Olivia Retallack of the New York State Office of Mental Health’s Suicide Prevention Office.

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The Zero Suicide Model holds that suicide prevention is a core responsibility of healthcare. Specifically, this entails a systematic clinical approach in healthcare systems—training staff, screening for suicide ideation, utilizing evidence-based interventions, mandating continuous quality improvement, treating suicidality as a presenting problem. The model’s developers argue that suicides can be prevented by closing cracks in healthcare systems—that “suicide deaths for individuals under care within health and behavioral health systems are preventable.”

King and Retallack called suicide “an enormous public health problem,” and noted that many people who take their own lives are receiving treatment in healthcare systems. According to data they presented, 80 percent of people who died by suicide had healthcare visits within the prior 12 months. And most had a recent visit: 45 percent had a primary care visit within a month of their deaths; and 19 percent had contact with mental health services within the past month.

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Inadequate training is part of the problem. In a 2014 survey of New York State mental health providers, 64 percent felt they had little or no specialized training for suicide intervention; 33 percent did not feel they had sufficient training to assist suicidal patients.

MacDougall recounted how Tompkins County Mental Health Services improved its suicide prevention efforts when it began adopting the Zero Suicide Model in 2016:

“What I realized was that we weren’t using evidence-based assessments or screening tools to ask the question. We were talking about depression. We were talking about things with our clients. But we didn’t actually use a specific screener, or a specific assessment that’s based on the best research available to ask the questions.

“So immediately we instituted C-SSRS [Columbia-Suicide Severity Rating Scale], it’s an evidence-based screening tool that you can use for everyone. And we use it for everyone who walks in our door for an intake, and we use it on a regular basis for anyone who is even coming close to discussing suicide or depression issues. That was one step we made from that first year.

“We also looked at the fact that we weren’t doing safety plans. We were doing an older version, like a recovery plan, or a plan of care, but not a true safety plan. So we use that on anybody who tests positive after asking the suicide assessment.

“The third thing we realized was that our staff wanted and needed more training. They were asking for more training. All of our staff completed online certification training on online webinars.

“Early progress from this is that I think we have staff who are far more trained and much better at identifying and engaging clients who have suicide [thoughts]. We actually just ask the question now. It’s not just the depression screening. We actually ask ‘Are you feeling suicidal?’ And we actually dig in deeper.”

The Sophie Fund, which sponsored The Watershed Declaration in April 2017 calling for intensified suicide prevention efforts in Tompkins County,  released a statement Monday following the coalition’s meeting:

“The Sophie Fund would like to thank the Tompkins County Suicide Prevention Coalition for supporting the Zero Suicide initiative. There are many agencies and individuals to acknowledge for their leadership, but we’d like to particularly thank Frank Kruppa and Sharon MacDougall of the Tompkins County Mental Health Services; Lee-Ellen Marvin of the Suicide Prevention & Crisis Service; and the Cayuga Medical Center, for its recent adoption of the Zero Suicide Model.

“We must do more to prevent suicide in Tompkins County. The Zero Suicide Model is an essential approach for saving lives. As the next step, The Sophie Fund renews its call on all the leading community and campus healthcare agencies in Tompkins County to commit to the Zero Suicide Model and to begin the implementation process as expeditiously as possible.

“We are experiencing a mental health crisis in the United States—and we must step up to meet that challenge. A terrible part of that crisis is the alarming rise in suicides. Just this month, the Centers for Disease Control and Prevention released a report that the national suicide rate increased 25.4 percent from 1999 to 2016. There are more than 1 million suicide attempts every year. It is the second leading cause of death among young people 15-24 years of age.”