Zero Suicide: Implementing the Model in Health Systems

Brian Ahmedani, director of the Center for Health Policy and Health Services Research at the Henry Ford Health System, argues that a two-decade surge in the United States suicide rate underlines the need for greater efforts to prevent deaths by suicide.

“The suicide rate is the only cause of death right now in the U.S. that over the last 20 years has actually been increasing,” said Ahmedani in his presentation, “Implementing Zero Suicide in Health Systems,” at the Suicide Prevention Center of New York’s “AIM for Zero: Suicide Care is Healthcare” symposium September 28-30.

“All of the other leading causes of death in the U.S. have annual rates that are either relatively stable or have actually been dropping pretty substantially over this period,” he said.

Ahmedani made the case for preventing suicide in healthcare by pointing to his own landmark research published in 2014 based on data from nearly 6,000 suicide deaths that more than 80 percent had seen a healthcare provider in the previous 12 months, almost 50 percent within a month, and more than 20 percent within a week.

Moreover, he said, the greatest number of individuals who died by suicide were not receiving mental health services, and more than half did not have a mental health diagnosis, pointing to the importance of using other healthcare settings such as primacy care practices to identify suicidal individuals.

“We really need to think about how we can put high intensity services in the settings where the fewest people go but who are at the highest risk, and then make sure that we also have low intensity services in those settings where there’s lots of people going to get care and most people are not at risk but where most people are touching before they die by suicide,” he said.

Part 4 in a Series about the Zero Suicide Model for Healthcare

Ahmedani credited the 2012 National Suicide Prevention Strategy for the landmark mandate determining that suicide prevention is a core responsibility of healthcare. He said that the Zero Suicide Model, developed at Henry Ford, took that mandate forward and provides the tools for a “golden era” of preventing suicide in healthcare.

At Henry Ford, he said, “We really focused on providing better care overall for our our patients and after doing that we saw a pretty substantial 75 to 80 percent reduction in suicide deaths over time in our in our health system. We were able to sustain that for almost 20 years now. You can think about all the numbers of lives that have been saved just because of that kind of care.”

He credited the development of many tools throughout the last 20 years, such as the PHQ-9 Patient Health Questionnaire, C-SSRS Baseline Screening, Brown Stanley Safety Plan, Dialectical Behavior Therapy (DBT), and Collaborative Assessment and Management of Suicidality (CAMS).

“This field is in its infancy stages, but yet we have all of the tools now,” Ahmedani said. “So we are in the opportunity phase of being able to implement those things into practice, and to use not only the knowledge that’s available from, and the structure that we developed at, Henry Ford, but also piggyback on all the research that’s been done across this entire time.”

“We also need the leadership and and the bold vision to push these things forward,” he added.

Ahmedani shared that Henry Ford is participating in three initiatives to further advance the Zero Suicide Model.

He said that Henry Ford and Kaiser Permanente are currently involved in a five-year study in six healthcare systems in Michigan, Washington State, Colorado, Oregon, and California covering 10 million patients a year to evaluate implementation of the Zero Suicide Model. The study is examining the health system metrics for driving implementation, fidelity to those metrics, and whether faithful implementation reduced suicide deaths.

A second initiative is a five-year comprehensive program to “revolutionize” suicide care within the Henry Ford Health System’s emergency departments, he said. It entails universal screening of every ED patient, risk assessments and safety plan counseling for positive screens, bridging referrals to behavioral health care through telehealth appointments with therapists, and post-discharge caring contacts.

Finally, Ahmedani said that through an initiative called MI-MIND, Zero Suicide processes are going to be implemented over the next few years in the five largest healthcare provider organizations across the state of Michigan in coordination with Henry Ford.

“We’re facilitating a suicide learning collaborative with healthcare systems that includes a monthly or a quarterly call to talk through their local implementation challenges, barriers, and opportunities, and work together as systems across the state,” he said.

“This is a model for going from one system, doing core implementation in behavioral health that spread to primary care, the emergency department, the hospitals, and all of our systems internally, to then spreading to new and revolutionized opportunities across multiple systems across the state,” he said.

“We have done this in Michigan, we have done this in different places across the state, and each of you have the opportunity to use this as a model to work across New York. Let’s let Michigan, let’s let New York, be leaders in the nation in suicide prevention.”

Ahmedani said that the Zero Suicide has been adopted by the national health systems or local health systems in more than 20 countries. “This this thing is growing like wildfire,” he said.

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.