Tompkins County Adopts the Zero Suicide Model

The Tompkins County Legislature on Tuesday unanimously passed a resolution to support the Zero Suicide Model, calling on local healthcare and behavioral healthcare providers to follow the model’s systematic clinical approach to preventing suicides.

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Tompkins County Legislature July 17, 2018

“This is an initiative we can be proud of,” said Shawna Black, chair of the legislature’s Health and Human Services Committee, who sponsored the resolution. “We are going to be one of the first counties in New York State to implement Zero Suicide.”

“We have a lot of work to do as a county to support those that struggle with mental health issues,” Black added. “However, the conversation will continue and our goal of zero suicides will set the standard for our community and it’s providers. As a community we realize the need for honest conversation about suicide prevention and the tools we must implement in order to save lives. I would like to thank the many providers that offer service on a daily basis and for their commitment to the zero suicide initiative.”

The legislative passage of Resolution 7950 came a month after the newly formed Tompkins County Suicide Prevention Coalition voted overwhelmingly to recommend the Zero Suicide Model for healthcare providers as a countywide suicide prevention initiative.

Jay Carruthers, director of the New York State Office of Mental Health’s Suicide Prevention Office, commended the county’s efforts to implement Zero Suicide.

“The suicide prevention work done at the community level in Tompkins County over the last two to three years has been extraordinary,” Carruthers said in a statement to The Sophie Fund. “Creating community partnerships, raising awareness, decreasing stigma, forming a coalition, and most recently working to integrate suicide prevention in health and behavior healthcare services—the Zero Suicide Model—it’s a wonderful accomplishment.

“In fact,” Carruthers added, “a big topic of conversation at Governor Andrew Cuomo’s Suicide Prevention Task Force this year has been how to support robust suicide prevention at the local level. No one approach is going to be enough to materially reduce the number of suicides. It takes community-level public health approaches, a commitment to deliver suicide safer healthcare, and the creation a culture of data-informed programming. The partnership between Tompkins County and the state has been truly exemplary in moving in this direction.”

Sharon MacDougall, Tompkins County deputy commissioner of mental health services, said “the support from our community, the Tompkins County Health and Human Services Committee, and the Legislature is inspiring and incredibly meaningful to our behavioral health providers and clients. Tompkins County Mental Health Services is honored to collaborate with our partners to push forward a vision and commitment for Zero Suicide in our community.”

MacDougall noted that including Tompkins County Mental Health Services, a total of seven local healthcare providers have become “Zero Suicide Champions” by committing to implement the model: Cayuga Medical Center; Alcohol & Drug Council of Tompkins County; Suicide Prevention & Crisis Service; Cornell Health of Cornell University; Family & Children’s Service of Ithaca; and CAP Plan/Preferred.

David Shapiro, president and CEO of Family & Children’s Service, commented: “F&CS has for many years been at the forefront of suicide prevention in Tompkins County through the staff training, team support, and clinical supervision that have become hallmarks of our clinical program. F&CS is one of the founding members of the Tompkins County Suicide Prevention Coalition. Along with committing to the Zero Suicide Model, F&CS is also committed to be a Zero Suicide Champion and will share what we learn with the broader community so that we can all be better prepared to help people who may be at risk to commit suicide. Our commitment to the Zero Suicide Model sets a lofty goal with an aspirational challenge.”

Kent Bullis, executive director of Cornell Health, commented to The Sophie Fund: “Cornell Health supports the Zero Suicide model, and is committed to completing the Zero Suicide Organizational Self-Study this summer and reporting out our experience to the Tompkins County Suicide Prevention Coalition in the spring.”

In March, Cayuga Medical Center became the first major healthcare provider in Tompkins County to endorse the Zero Suicide initiative. “Cayuga Medical Center is committed to Zero Suicide and is currently studying what resources we need to implement,” David Evelyn, vice president for medical affairs, told The Sophie Fund. “We are pursuing the self-assessment.”

In comments to the Legislature prior to Tuesday’s vote, Scott MacLeod of The Sophie Fund said that “adopting the Zero Suicide Model is an important step in addressing the public health problem of suicide and the rising suicide rate.” The Sophie Fund sponsored The Watershed Declaration adopted exactly 15 months earlier in which local healthcare providers pledged to intensify suicide prevention efforts in Tompkins County. The Sophie Fund also co-hosted an expert briefing on the Zero Suicide Model last October at The Statler Hotel on the Cornell campus.

MacLeod thanked the Tompkins County Legislature and the Zero Suicide Champions for their support for the Zero Suicide Model. He also thanked and cited the valuable support provided by Jay Carruthers, director of the state Suicide Prevention Office; Associate Director Sigrid Pechenik; Garra Lloyd-Lester, associate director of the Suicide Prevention Center of New York State; and Michael Hogan, a former New York State mental health commissioner and a developer of the Zero Suicide Model.

The Tompkins County resolution reads in part:

WHEREAS, the Tompkins County Suicide Prevention Coalition endorses the Zero Suicide model as a framework for organizational commitment to safer suicide care in health and behavioral health care systems, and

WHEREAS, suicides are preventable, now therefore be it

RESOLVED, on recommendation of the Health and Human Services Committee, That Tompkins County hereby signs onto the Zero Suicide model to reduce the number of people committing suicides, commit to sharing lessons learned with other counties to support a state-wide initiative and encourage all health and behavioral healthcare to participate in the Zero Suicide model…

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Shawna Black (center), chair of the Health and Human Services Committee

The Zero Suicide Model, sometimes called the “Suicide Safer Care Model,” holds 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.

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—and not simply relying on the heroic efforts of crisis staff and individual clinicians.

As the Suicide Prevention Resource Center (SPRC) puts it:

“The programmatic approach of Zero Suicide is based on the realization that suicidal individuals often fall through multiple cracks in a fragmented and sometimes distracted healthcare system, and on the premise that a systematic approach to quality improvement is necessary.”

The facts make a compelling case that healthcare settings must play a critical role in preventing suicide. A review of New York State data of 3,564 suicides in 2013–2014 identified that 25 percent of the individuals who took their own lives had been discharged from emergency departments or inpatient facilities within just seven days prior to their suicide deaths.

The data also indicates a strong need to better train clinicians in suicide screening, assessment, intervention, and follow-up. Of 1,585 mental health providers surveyed by the New York State Office of Mental Health in 2014, 64 percent reported little or no specialized training in suicide-specific interventions. Moreover, about 33 percent reported that they did not feel they had sufficient training to assist suicidal patients.

Zero Suicide is at the heart of the 2012 National Strategy for Suicide Prevention, released by the U.S. Surgeon General and the National Action Alliance for Suicide Prevention. The NSSP’s Goal 8 is to “promote suicide prevention as a core component of healthcare services.” Goal 9 is to “promote and implement effective clinical and professional practices for assessing and treating those at risk for suicidal behaviors.”

Zero Suicide is explicitly embraced by the NYS Suicide Prevention Plan 2016–17, entitled 1,700 Too Many. Implementing Zero Suicide in health and behavioral healthcare settings is the first pillar of the suicide prevention strategy outlined in the plan. The second pillar is to “create and strengthen suicide safer communities.”

The Zero Suicide Model builds on breakthroughs such as the Perfect Depression Care Initiative implemented in 2001 by the Henry Ford Health System in Michigan. Its comprehensive approach to mental and behavioral healthcare—incorporating suicide prevention as an explicit goal—demonstrated a 75 percent reduction in the suicide rate among Henry Ford health plan members.

Grasping the Profound Pain of Suicide

Describing depression to those who haven’t experienced it can be clumsy. The analogy I’ve found that best embodies my experience is “cloudy days.” The sun is still there but I’m unable to access that light. Instead, I’m cold and muted. Sometimes it’s cloudy for so long it’s hard to remember what the sun looks like. Sometimes it’s hard to believe the sun is there at all.

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A sculpture from “Schism” representing Sophie Hack MacLeod

As someone who has battled depression for years and intimately understands the pain surrounding suicide and mental illness, I want my art to make a statement about this epidemic. Art is visceral and can describe an effect or experience in deeply powerful ways. This, and my drive to grow as an artist, pushed me to complete a minor in fine arts as an undergraduate at Cornell University.

My installation, “Schism,” is featured in Still I Rise, an exhibition curated by Laura Rowley with the work of 12 artists on view at the Tompkins County Public Library from July through September. “Schism” deals with the pain of losing loved ones to suicide, commenting on the profound hole the deaths leave behind. With rising mental health concerns among my generation, the ability to outwardly mourn for people who die by suicide is incredibly important along the path to healing.

Yes, suicide is a sensitive topic. No, this doesn’t mean we shouldn’t talk about it. Treating suicide as a taboo topic not only stunts the healing process for suicide loss survivors, but teaches those plagued with suicidal thoughts that it’s something to be ashamed of, a weakness, which can deter them from seeking support. Open and empathetic conversation is critical to combat such tragedy.

“Schism” contains three sculptures. Each is a life-size, wooden silhouette of a suicide victim that is painted black with the best runner up to Vantablack commercially available, Black 2.0. It’s a special paint that is meant to absorb a higher percentage of light, creating the visual effect of “a schism in space.” This is meant to convey the loss felt when someone is a victim to suicide, to reveal the hole that remains in their physical shape in space they inhabited in life.

This installation is designed to represent loss of the individual, as each sculpture is a personalized and unique silhouette. Further, it is intrinsically connected to Ithaca as the individuals represented were all affiliated with the area: Sophie Hack MacLeod, 23, a Cornell fine arts major; Jason J. Seymour, 40, a Cornell systems analyst; and Alexander Joseph Reposh, 25, an Ithaca filmmaker and musician.

When someone is having suicidal thoughts, it’s far too easy to think, “I don’t matter, no one will even miss me, what’s the point? It’s suffocating.” I hope that “Schism” can be a reminder to those experiencing suicidal thoughts that your life is not trivial but is something to be cherished. “Schism” is also a symbol for those mourning a loved one and the horrific loss they must cope with.

—By Brianna Evans

briannaBrianna Evans is a 2018 graduate of the College of Agriculture and Life Sciences at Cornell University. “Schism” was created as an independent study project supervised by Professor Roberto Bertoia of the College of Architecture, Art, and Planning. She wishes to thank The Sophie Fund, and the families of Sophie Hack MacLeod, Jason J. Seymour, and Alexander Joseph Reposh, for their support.

“Be the Change You Want to See”

When the story of American authorities separating children from their parents at the U.S.–Mexico border hit the headlines in mid-June, we knew we had to act. Six of us—Cornell University students staying in Ithaca during the summer break—met up and brainstormed what we could do.

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We were deeply concerned about the consequences of the Trump administration’s “Zero Tolerance” policy targeting asylum seekers and other migrants.  The Department of Homeland Security reported that 2,342 children had been separated from adults between May 5 to June 9. Many psychologists and health professionals condemned the separation and detention of children as a traumatic, emotionally damaging experience that could cause them “irreparable harm.” We were mindful, too, that nearly 100 South Asian asylum seekers were being detained in Oregon.

Motivated by what we saw as a gross abuse of political power, and inspired by the mass action taking place across the country, we decided to support fundraising for the Refugee and Immigrant Center for Education and Legal Services. RAICES is one of the largest immigrant rights nonprofits in Texas that has been supporting immigrants and their families in securing legal representation, translation services, and other services. Almost overnight, a Facebook campaign had raised more than $20 million for the organization.

I remember wanting to donate but feeling helpless because I could not afford more than $5.00 from my own pocket. From the ubiquity of Facebook posts and conversations that were happening around the issue, I realized that many felt the same way. Unaware of any other effort to mobilize contributions from the Cornell community, six of us—Tarannum Sarwat Sahar ’20, Rose Ippolito ’20, Lizzie Lee ’19, Jaylexia Clark ’19, Anuush Vejalla ’20, and myself—got to work with three ideas in mind.

First, we wanted to multiply the amount of money we could have donated on our own. We also wanted to engage people on the family separation issue face to face. Lastly, we wanted to restore our own faith that positive and swift action could be taken by college students against injustices, even during a time of year when we are “on break.”

We figured we wouldn’t raise a huge amount—we would be content with even $200. On June 26, we began a week of tabling at the bus stop in front of the Schwartz Center for the Performing Arts. We had to cancel two of the days due to the weather, but were overjoyed to have raised almost $560 by the weekend. We were excited by the prospect of reaching $750—half of the $1,500 minimum needed to pay the bond for a detained migrant at the border.

Suddenly, we experienced a dispiriting misfortune—during our Saturday shift, an individual stole the entire contents of the cash box, taking off with most of the donations we had received at that point.

The blow was difficult to bear in the moment. June 30 happened to be the date when thousands of people in Ithaca and across the United States were marching and protesting the Zero Tolerance policy and family separation. So we took to our online networks and began to spread the tale of our predicament to our friends in every corner of the country, and even to the friends who were abroad for the summer. Within 20 minutes, I saw my personal Venmo account jump by nearly $100.

Our donations surged past $500 just a few hours later. It was utterly surreal. Over the next 24 hours, money continued to arrive, in $20, $10, and $5 increments—and even one 87-cent donation. By Sunday afternoon, we crossed the $1,000 mark with more donations pouring in.

For us, this became a story of a community coming together—people rallying around the immigration issue, and also friends responding to our SOS. It was incredible to see our friends (and also people we didn’t know!) contributing their support so quickly and generously.

We are extraordinarily grateful for the kindness and goodness of those around us. We know that in the end, this goodness will always drown out the negative actions of others. We are extremely thankful for every single donor, every single volunteer, and every single person who has taken interest in our fundraising effort.

Throughout the week, we talked to more than 200 people passing by our table. They gave us spare change, any dollars they could spare, and more importantly, took out time in their day to support a simple idea: #KeepFamiliesTogether. We want this to serve as a reminder that there is always a way to be the change you want to see in the world—no matter what time of year, no matter with what resources, and even when upsetting things happen.

Our fundraiser is closed–our final total was $1,120–but we ask that any and all further donations be sent directly to RAICES via its website here (scroll down to the donate box).

—By Winnie Ho

Winnie Ho is a senior in Cornell University’s College of Arts and Sciences studying neurobiology and sociology