Month: November 2021

Zero Suicide: Transforming Healthcare, Eliminating Suicide

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C. Edward Coffey, a professor of Psychiatry and Behavioral Sciences at the Medical University of South Carolina, begins his presentation with a statement that is both a troubling snapshot and a call to action: “We have a real crisis in this country with regard to suicides.”

Coffey’s presentation, “Vision Zero: Eliminating Suicide & Transforming Healthcare,” the kickoff session of the Suicide Prevention Center of New York’s “AIM for Zero: Suicide Care is Healthcare” symposium September 28-30, noted that suicide rates in the United States increased 35 percent from 1999 to 2019.

Coffey cited the landmark “Crossing the Quality Chasm: A New Health System for the 21st Century,” a damning report by the Institute of Medicine two decades ago, for helping lay the foundation for Zero Suicide, a model aimed at preventing suicides among patients in healthcare systems.

“Our thought leaders are saying back in 2001 that our system is broken,” Coffey said. “And, furthermore, it is so badly broken that we’re not going to fix it by tweaking at the margins. We need to basically tear it up and start over. Remember, this criticism is not coming from a fringe group, but was authored by the thought leaders in international healthcare.”

Part 1 in a Series about the Zero Suicide Model for Healthcare

Coffey pointed to 2021 research published by the Commonwealth Fund showing how the United States ranked “dead last” among well developed high income nations in overall healthcare, access to care, administrative efficiency, equity, and outcomes. The same research, he noted, found that the U.S. ranks dramatically lower than the other nations in value for money spent on healthcare. “Although the Chasm report was written 20 years ago and it bemoaned our healthcare system then, the unfortunate news is that problems persist,” he said.

The Chasm report described six dimensions of ideal healthcare, Coffey explained; “healthcare should be safe, effective, patient-centered, timely, efficient, and equitable.”

He took up the challenge himself by becoming a leader in developing what has become known as the Zero Suicide Model, designed to prevent suicide deaths through systemic quality improvements within healthcare systems. In the early 2000s, Coffey led the Perfect Depression Care Initiative at Michigan’s Henry Ford Health System. The initiative achieved an 80 percent reduction in suicide deaths among Henry Ford patients including a decline to zero suicides in some annual reporting periods.

With a grant from the Robert Wood Johnson Foundation, the initiative sought to apply perfection goals for suicide prevention to the Chasm report’s elements of ideal healthcare. It began by applying the audacious goal of eliminating suicides to the element of effective care. Other goals included eliminating medication errors and achieving 100 percent patient satisfaction in the areas of patient-centered care, timely care, efficient care, and equitable care.

Coffey stressed that improving suicide care requires creating a “just culture” in the healthcare workplace, a “culture in which mistakes and errors are viewed as system issues, not personal failings, [and] are viewed as opportunities for learning and for improving the system, not punishing people. It’s profoundly important. We can’t ask our teammates to go up to plate and try to hit a home run every time, and then turn right around and punish them for striking out.”

Zero Suicide protocols that grew from the Henry Ford experiment include leadership of a system-wide culture change committed to reducing suicides, training a competent workforce, identifying individuals at risk with comprehensive screening and assessment, engaging at-risk individuals with care management plans, treating suicidal thoughts and behaviors with evidence-based treatments, and transitioning patients through care with warm hand-offs and supportive contacts.

Coffey said that early adopters of the Zero Suicide Model are now replicating Henry Ford’s advances. Among them: Centerstone, which provides mental health and addiction services in Tennessee and other states; Gold Coast Mental Health and Specialist Services, in Australia; and 110 community mental health clinics in New York State.

Coffey noted how Zero Suicide’s standards and goals are embedded in U.S. health policy and accreditation guidelines and requirements, such as the 2012 National Strategy for Suicide Prevention and The Joint Commission’s National Patient Safety Goal for Suicide Prevention (NPSG) 15.01.01.

Addressing colleagues who bemoan the immense challenges of preventing suicide deaths, Coffey recalled the internal discussions in developing the Perfect Depression Care Initiative at Henry Ford.

“What number of suicides are we going to tolerate? Is 12 suicides a year the right number? Is that numbering your parent or my sister? We realized that the only answer to this question is zero. Our goal has to be zero. And at that moment, our department was transformed. We stopped trying to be the best, we stopped trying to improve incrementally, and we began to strive for perfection in all of our goals. What does it mean to be the best in a mediocre industry? ‘Being the best’ isn’t good enough. We’ve got to pursue perfection.”

Coffey emphasized the importance of leadership in implementing the Zero Suicide Model. “Leadership involvement is essential to the success of this kind of work,” he said. “This cannot be the flavor of the month. It can’t be the quality improvement project of the month. It has to be a system-wide initiative.”

READ MORE: The Zero Suicide Model in Tompkins County

If you or someone you know feels the need to speak with a mental health professional, you can contact the National Suicide Prevention Lifeline at 1-800-273-8255 or contact the Crisis Text Line by texting HOME to 741-741.

Call to Action: Suicide Prevention in Tompkins Healthcare

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Jenna Heise, who became the director of suicide prevention implementation for New York State earlier this year, tells of a powerful moment in her work during her previous position at Texas Health and Human Services.

She was attending a high school event in Corpus Christi where a young man spoke. He had been treated for suicidality at a hospital that practiced Zero Suicide, a suicide prevention model for healthcare systems. “The principal come up and said, with tears in her eyes, ‘That young man, he’s alive because of you,’” Heise recalled.

Heise, widely recognized for her work in advancing the Zero Suicide Model in Texas and beyond, related the story during “Call to Action: Suicide Prevention in Healthcare,” a special presentation on the Zero Suicide Model for Tompkins County’s healthcare leaders sponsored by The Sophie Fund on November 16. The presentation via Zoom was attended by senior leaders from 11 hospitals, college health centers, and community behavioral health services, and a representative of the Tompkins County Suicide Prevention Coalition.

Heise used her Corpus Christi story to illustrate the potential of the Zero Suicide Model. “I did this in Texas, across 254 counties, in a statewide effort,” she said. “I know that you can do this. Yes, it works. I can’t tell you how many times I have heard from staff, how many times I’ve been on calls where I’ve heard from loved ones.”

She pointed to healthcare systems where Zero Suicide has been implemented with success, notably the Henry Ford Health System in Michigan. She said that within four years the suicide rate among its patients decreased by 75 percent. In some years the system recorded zero suicide deaths compared to an average 89 suicides per year previously.

Citing data that shows rising death rates, Heise called suicide a “public health crisis.” She said suicide was the second leading cause of death in the U.S. for people in the 10-14, 15-24, and 25-34 age groups, and the 10th leading cause of death overall. She referenced local data indicating that Tompkins County has averaged 12 suicide deaths per year in the past five years, and noted that each suicide tragedy impacts many other individuals such as family members, friends, colleagues, and peers.

Heise said that healthcare providers have traditionally treated suicidal patients in a fragmented approach, whereas the Zero Suicide Model brings together a framework of best practices for a more effective safety net for suicidal individuals seeking professional healthcare. The framework, she added, is based on “mind blowing” research into how to prevent suicide deaths.

“We don’t have to wonder what works,” she said. “We don’t have to throw the kitchen sink at it anymore. We can know what works, and we can use that.” She compared the promise of working more confidently with the Zero Suicide Model with her own experience as a young clinician, when she felt like “a deer in the headlights” when confronted with treating people who had made a suicide attempt.

She argued that it makes sense for prevention efforts to focus on medical providers because so many people who take their own lives are seeing healthcare professionals. She said that 80 percent of people who died by suicide had a healthcare visit in the year before their death. Forty-five percent had a primary care visit, 37 percent an emergency department visit, and  20 percent contact with a mental health service.

Heise quoted Michael Hogan, a former mental health commissioner for New York State and a co-developer of the Zero Suicide Model, saying, “We should treat suicide prevention in health care systems as we treat heart attack prevention.”

Heise walked the Tompkins healthcare leaders through the elements of the Zero Suicide framework, starting with the critical importance of top leadership. “When we talk about leadership, we’re talking about buy-in from the top down,” she explained. “We have to have leaders. Without every level of the agency working together with a consistent message and plan, it’s doomed to fail.”

Training staff in using evidence-based tools is essential, Heise said. She highlighted the importance of properly using the correct screening and assessment tools to identify suicidal individuals and provide them with an appropriate care plan. She noted that the model also calls for engaging patients through developing safety plans that provide them with coping skills for averting crises, and for the use of proven therapies for directly treating suicidality, such as Cognitive Behavioral Therapy for Suicidal Patients (CT-SP).

Ensuring safe transitions through care is another key element of the model, Heise said. This involves “warm handovers” when additional professional services are needed, and following up with suicidal individuals with “caring contacts” such as emails, texts, or postcards. Finally, she said, Zero Suicide calls for continuous attention to improving policies and procedures through data collection and other assessment measures.

“It’s a bundle of best practices that you use from the minute you meet the patient, all the way through their intake, their time with you, they’re getting ready to leave, and then the time they leave their care with you,” Heise said. “And then you follow up with them. It’s the entire continuum of care.”

Heise encouraged providers who have not already embarked on implementing the Zero Suicide Model to begin the process by conducting the Organizational Self-Study and Workforce Survey found in the model’s toolkit.

“Look at your organization as a whole, and where you are with certain best practices for suicide care,” she said. “The work force study is where you send out this blanket survey to all of the folks at your agency, to let you know what they know and don’t know.”

Heise said that Zero Suicide promotes a “just culture” in healthcare because it emphasizes the role of the system rather putting responsibility for suicide care and suicide deaths on individual clinicians. “We call it a preventable death, and what we mean by that is not that any of us could have stopped somebody from dying by our single efforts,” she said. “This is really looking at the bigger picture.”

Following Heise’s presentation, Scott MacLeod, co-founder of The Sophie Fund, announced planning for follow-up events to advance the Zero Suicide Model in Tompkins County; they included an expert briefing for healthcare managers and an introductory presentation for primary care practices.

The Sophie Fund proposed that Tompkins County healthcare leaders begin a formal and regular dialogue on Zero Suicide to share ideas and experiences, and to work on securing funding for a county implementation coordinator and training programs, MacLeod said.

He acknowledged the tremendous pressures and stress on healthcare providers amid the Covid-19 pandemic, but expressed hope that leaders will respond to the “Call to Action” with further efforts to implement the Zero Suicide Model.

“We are grateful for your work to improve suicide care in Tompkins County,” he said. “We invited our community’s top healthcare leaders to this ‘Call to Action’ today because leadership is the number one element of the Zero Suicide Model.”

The Sophie Fund launched a Zero Suicide initiative in 2017 by organizing an expert briefing on the model for local healthcare leaders. In 2017, the model was recommended by the Tompkins County Suicide Prevention Coalition and endorsed by the Tompkins County Legislature.

The Sophie Fund organized the November 16 Zero Suicide presentation to support the New York Office of Mental Health’s renewed focus on implementing the Zero Suicide Model and the U.S. Surgeon General’s 2021 Call to Action to Implement the 2012 National Strategy for Suicide Prevention.  

Among those attending Heise’s presentation were Frank Kruppa, director of the county Health Department and commissioner of Mental Health Services, and Harmony Ayers-Friedlander, deputy commissioner.

Other agencies represented were Cayuga Medical Center; Cayuga Health Partners; Guthrie Cortland Medical Center; Suicide Prevention and Crisis Service; Family & Children’s Service of Ithaca; MindWell Center LLP; REACH Medical; Cornell Health, Cornell University; Center for Counseling and Psychiatric Services, Ithaca College; and Health and Wellness Services and Mental Health Counseling, Tompkins Cortland Community College.

READ MORE: The Zero Suicide Model in Tompkins County

If you or someone you know feels the need to speak with a mental health professional, you can contact the National Suicide Prevention Lifeline at 1-800-273-8255 or contact the Crisis Text Line by texting HOME to 741-741.

Kids Getting Bullied: What Adults Can Do

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Bullying can have serious immediate and lasting harmful impacts on children, yet 64 percent of those who are bullied do not report the experience to an adult, according to Bailey Huston, coordinator of PACER’s National Bullying Prevention Center. Huston spoke at “Kindness, Acceptance, and Inclusion in the Age of Covid-19,” a webinar hosted by the Tompkins County Bullying Prevention Task Force on October 27 in a program marking National Bullying Prevention Month.

DOWNLOAD: Resources from PACER’S National Bullying Prevention Center

Huston reviewed the four main types of youth bullying: verbal bullying, using words to tease or harass; emotional bullying, such as manipulation, gossip, or exclusion; physical bullying, such as kicking, hitting, damaging or stealing property, or unwanted touching; and cyberbullying, using technology such as social media to hurt or harm.

“We all know that conflict is a normal part of a kids life, and it can be hard to figure out if it is bullying or just conflict,” Huston said. Yet, she added, it is crucial to understand the distinction. She explained that conflict is between individuals of equal circumstance who are not seeking to cause harm, whereas bullying involves a power imbalance where a perpetrator is not concerned about causing harm and may actually be motivated by a desire to control.

“Some common views about bullying are that ‘It’s part of growing up,’ ‘It makes you tough,’ ‘Kids will be kids,’ ‘It’s only only teasing,’” said Huston. “But bullying should not be part of growing up.” In fact, she argued, bullying can negatively impact a child’s education, health, and safety.

Students who are bullied may avoid going to school, which can cause a decline in academic performance and even dropping out, Huston said. Bullying can lead to stomach aches, headaches, and sleep problems, and emotional problems like depression and anxiety, she said. Finally, bullying behavior can result in physical harm to bullies and their targets, she said.

It is important to emphasize, Huston said, that bullying is a behavior, and behavior can be changed. The focus on addressing bullying should be on the behavior, and not the person, she said.

“We avoid using words like the ‘bully’ or the ‘victim,’” she explained. “Behavior like bullying can be changed. It is not a permanent part of who they are. This behavior does not have to define them. When you pull back those layers, we can see there are number of ways we can redirect the behavior in positive ways.

Huston advised parents to talk to children about bullying, and support and empower them if they are bullied. She encouraged parents to start a conversation with their children at a young age, and to provide constructive backup if and when they experience bullying. She said it is important for children to know that being bullied is not their fault and not their responsibility alone to stop the bullying. Huston said students should be encouraged to report bullying to a teacher or trusted adult, and advised against encouraging them either to stand up to the person bullying them or to just ignore the bullying.

Huston noted that PACER’s National Bullying Prevention Center provides a wealth of educational as well as support materials on its website.

To address a serious bullying problem, Huston suggested developing actions plans. She said a “Student Action Plan” can reflect on the issue and develop steps to change the situation. A “Parent Action Plan” should keep a record of incidents which should include any written information, the date of the event or events and person or persons involved, and their child’s own account of what happened, she said.

Additionally, Huston said, parents should decide on the best approach for taking action—for example, whether to approach school staff, health professionals, law enforcement, or other community members about the problem. She said parents should learn their legal rights in the situation, and know the procedures for reporting a problem. Many schools have specific procedures for reporting incidents, but Huston noted that Pacer’s website provides a template letter that parents can use as well. (Click here to download).

For more resources, click here for The Sophie Fund’s bullying prevention page.