Zero Suicide: Transforming Healthcare, Eliminating Suicide

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.