Advancing “Zero Suicide” in Tompkins County

The Sophie Fund on March 24 hosted “Implementation of Zero Suicide,” a suicide prevention presentation for front line managers representing 10 leading healthcare providers in Tompkins County.

Tammy Weppelman, the State Suicide Prevention Coordinator at the Texas Health and Human Services Commission, outlined the seven elements involved in implementing the Zero Suicide Model. Weppelman was joined in her presentation by Mike Olson, the crisis program manager at My Health My Resources, an agency currently implementing the model in in Tarrant County, Texas.

The Zero Suicide Model is designed to eliminate gaps in systems of care for treating patients experiencing suicidal behaviors; research has shown that more than 80 percent of people who died by suicide had seen a healthcare provider in the previous 12 months, almost 50 percent within a month of their death, and more than 20 percent within their final week of life.

“Suicide prevention is a core function of the organization, it’s everybody’s business,” Weppelman said. “Suicide is preventable. The culture in your organization is a just culture, which means that you look at suicide as a system failure rather than an individual failure. It’s not an issue with a specific clinician or something that one person did that led to someone dying by suicide. But, collectively, as a organization, or as a system, what can we do better to prevent suicide.”

LEARN MORE: The Zero Suicide Model in Tompkins County

Weppelman said that leadership, the first element of the model, entails a healthcare provider creating an implementation team. She said it was essential that the team include top leadership decision-makers as well as individuals within the organization who are personally passionate about preventing suicide.

“Leaders are easily drawn to other priorities,” she explained. “But the passion on your implementation team, they’re not going to be drawn to other priorities. They’re going to keep that team driving forward.”

Olson discussed evidence-based training as a second element of Zero Suicide, “making sure that especially your direct care staff, or your front line staff, is competent in suicide prevention, but also confident in their ability to identify suicide risk and respond to that risk appropriately.”

He said that training provides skills for universal screening for suicide risk, assessment of treatment needs, and safety planning. A tangible first step, he added, calls for healthcare organizations to administer a workforce survey about suicide prevention capabilities at least every two to three years.

Weppelman reviewed a third element, identifying suicide risk. In all healthcare settings, she explained, “we want to do universal screening, screening every person, every visit, every time.” A recommended tangible first step, she said, is choosing a screening tool, such as C-SSRS or ASQ.

“In my experience, people don’t come out and say they’re having thoughts of suicide without somebody asking them,” she explained. “If you do ask, most of the time they’re honest, because they know that it’s a safe place or a safe person to talk to. So the the benefit of universal screening is that if you ask, you’re going to catch people. And if you don’t ask, you’re not.”

“I’ve heard somebody say, ‘It seems like a lot. What if somebody comes in every week? You ask them every week about suicide?’ Yes, it’s kind of like every time you go to the doctor you get your blood pressure taken, you get your temperature taken. Asking about suicide is like a mental health vital sign.”

The next element of Zero Suicide is to engage people who screen for high risk in a care management plan, a clinical pathway, Olson said. He said that this involves developing an individual safety plan with the patient, such as one using the Brown-Stanley Safety Plan template, that provides quick tips for self-care in a crisis, emergency contact information, and a reminder to remove access to any lethal means. Care management will also entail ongoing risk assessment and procedures for follow up care, he said.

Weppelman said that another element is using evidence-based treatment interventions. She explained that Zero Suicide calls for interventions that are specific to reducing suicide risk, as opposed to treatments for illnesses such as depression that are thought to be related to suicide. She said that recognized suicide-specific interventions include Collaborative Assessment and Management of Suicidality (CAMS); Dialectical Behavioral Therapy (DBT); and Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP).

Olson said that a sixth element focuses on the healthcare organization’s capacity to manage suicide risk during transitions in care. He said this includes supporting individuals transitioning from the emergency department or psychiatric hospitals; those who miss appointments or withdraw from care; and individuals transitioning to a new service provider.

He said that the transition element has been the trickiest for his agency. “Services are optional, we can’t force patients to to engage in services if they don’t want to,” he said.

Yet, Olson said, Zero Suicide calls for reengaging patients through “caring contacts”—“very basic correspondence just saying, ‘Hey, we haven’t seen you at the clinic in a while, you know we’re here for you if you need us.’” He said it also calls for “warm handoffs” to onward providers, so the patient “doesn’t fall through the cracks during that transition period.” He said his agency utilizes the Care Coordination Agreements and Care Transitions model for “making sure there’s timely follow up after any type of discharge from the hospital.”

“Individuals are 273 percent more likely to die by suicide within 30 days of a care transition, so these times are so super important,” Weppelman added.

Weppelman recalled her experience working in crisis services at a Dallas-Fort Worth area community mental health center that implemented Zero Suicide. She said that the center established memorandums of understanding with local hospitals so that when they discharged a patient in need of psychiatric follow-up for outpatient services, “they would be direct dropped to our door—within an hour of discharge, we would be seeing them.” When somebody presented at the emergency department after a suicide attempt, the center would dispatch a mobile crisis team to follow up, she said.

The seventh Zero Suicide element is continuous quality improvement. Weppelman said that this entails the use of data, keeping track of suicide deaths and suicide attempts within a provider’s system. She said that another aspect of improvement is developing a Zero Suicide implementation plan, starting with small goals that can be more easily achieved. She suggested doing one thing to drive efforts forward in the next 30 days, and then setting three goals for the next 90 days, and three goals for the next year.

“It’s not an initiative that you start today, and you end next week,” she explained. “It’s always a continuous quality improvement project.”

The presentation for front line managers was the third in a series of presentations and trainings on Zero Suicide hosted by The Sophie Fund.

It was attended by representatives from leading healthcare providers, including: Tompkins County Mental Health Services; Cayuga Medical Center; Cayuga Health Partners; Suicide Prevention and Crisis Service; Family & Children’s Service of Ithaca; Guthrie Cortland Medical Center; Alcohol & Drug Council of Tompkins County; Cornell Health and its Counseling & Psychological Services; Center for Counseling and Psychiatric Services at Ithaca College; and Health and Wellness Services and Mental Health Counseling at Tompkins Cortland Community College. The presentation was also attended by Sally Manning, convener of the Tompkins County Suicide Prevention Coalition.

Previous events included “Call to Action: Suicide Prevention in Healthcare,” an expert briefing on the Zero Suicide Model for Tompkins County healthcare leaders on November 16 by Jenna Heise, Director of Suicide Prevention Implementation at the Suicide Prevention Center of New York; and “Understanding, Identifying, and Addressing Suicide Risk: A Clinical Primer for Behavioral Health Providers” on March 9 by The Wellness Institute.

On June 16, Virna Little, CEO of Concert Health and a leading expert on integrating primary care and behavioral health, will provide a briefing for primary care physicians and their teams on implementing Zero Suicide protocols in primary care practices.

The Tompkins County Suicide Prevention Coalition on February 24 unanimously adopted a three-year strategic plan guided by a vision “for a community where no lives are lost to suicide” and using data, science, and collaborations to implement effective strategies; implementation of the Zero Suicide Model is one of the plan’s main objectives.

Zero Suicide is the healthcare pillar of “1,700 Too Many: New York State’s Suicide Prevention Plan 2016–17,” as well as of the 2021 “Surgeon General’s Call to Action to Implement the National Strategy for Suicide Prevention.”

Next Steps for Cornell Addiction and Recovery

Cornell Sober Housing, Inc. has changed its name to Cornell Collegiate Recovery, Inc. (CCR) to reflect its overall mission of advocacy to the Cornell University community about college student alcoholism, addiction, and recovery.

CCR is an independent nonprofit organization. Its board and supporters include faculty, alumni, and students committed to collegiate recovery. Since its founding in 2015, our mission has been multifaceted. We provide a clean and sober living environment for Cornell students, support their sobriety and recovery, and cultivate understanding throughout the broader Cornell community about substance abuse and addiction recovery.

At the end of the 2021-22 academic year, we will be closing our Sober House residence temporarily. This is an unfortunate consequence of Covid-19 and constraints on social gatherings, which have reduced the number of students associated with the Sober@Cornell student organization and who are interested in living in the house. In this context, we are shifting our focus to educating the Cornell University community—students, faculty, and administrators—about alcoholism, drug addiction, and recovery, and working with Sober@Cornell to rebuild its organization and programming.

Another in an occasional series of articles about student mentaOne in an occasional series of articles about student mental health. For more information, go to The Sophie Fund’s Student Mental Health Page

According to the Association of Recovery in Higher Education, approximately 160 colleges have recovery programs for students. Earlier college alcohol and drug programs focused on students drinking to excess (i.e., binge drinking) and gave little attention to students addicted to alcohol and other drugs because it was thought that alcoholics and addicts were primarily middle age adults. Alcohol is the dominant drug of choice among college students and most students drink moderately or are abstinent. National research finds that approximately 6 percent of college students are dependent upon alcohol and approximately 12 percent abuse alcohol. While students abusing alcohol can change their behavior and drink responsibly, either on their own or with professional help, students dependent upon alcohol and other drugs require alcoholism and addiction treatment to abstain and gain long-term sobriety.

The primary barrier to helping students recover from alcoholism and drug addiction is stigma. Cornell Collegiate Recovery, Inc. will work to reduce stigma and promote student access to treatment and long-term recovery through a variety of efforts:

  • Working with the Cornell University administration and Cornell Health to develop a comprehensive collegiate recovery program. We will seek to work with the Skorton Center for Health Initiatives to develop education efforts focused on teaching students about alcoholism, drug addiction, and recovery and how to seek help for themselves or fellow students suffering from alcoholism and drug addiction. We will seek to work with Counseling and Psychological Services (CAPS) to cross-train its clinicians in the diagnosis and treatment of mental health disorders and substance use disorders, particularly alcohol and other drug addictions.
  • Working with Sober@Cornell to revitalize its organization and rebuild its membership. We will work to promote a positive identity for students in recovery and a community of support through public relations campaigns and sponsoring sober events on campus.  
  • Working with student service professionals across campus to facilitate their ability to identify students who may be suffering from alcoholism and addiction and refer them to Cornell Health for appropriate diagnosis and treatment. Student service professionals also provide a critical role in supporting students in recovery to maintain their sobriety, achieve their full potential as Cornellians, and pursue successful careers after graduation.
  • Working with student organizations to promote an understanding of alcoholism, drug addiction, and recovery. For several years, we have brought Cornell alumni in recovery to campus to talk with fraternities and sororities. These FAST Talks have been well received, helping students to distinguish between responsible drinking and alcohol dependence and providing them with information on seeking help for themselves or friends. We will be promoting FAST Talks to other student organizations this year. We believe that peers helping peers is one of the best ways to help students suffering from alcoholism, and drug addiction and to support them in their recovery.

By William J. Sonnenstuhl, Alison Young, Tim Vanini, and Shawn Meyer

William J. Sonnenstuhl, Alison Young, Tim Vanini, and Shawn Meyer are officers of Cornell Collegiate Recovery, Inc.

In Our Own Voice

The National Alliance on Mental Illness (NAMI) works to end stigma around mental health through support, education, and advocacy in our community.

One NAMI program that promotes conversation and awareness on this topic is called In Our Own Voice, in which people with lived experience talk openly about what it’s like to live with a mental health condition through public presentations.

At NAMI Finger Lakes, we are growing the In Our Own Voice program to increase awareness and normalize discussions around mental health. We provide training using a NAMI signature program model for people with lived experience who wish to become presenters and help others through sharing their story.

NAMI-FL coordinates all presentations, which range in length, depending upon how many presenters participate. We can also facilitate virtual or in-person presentations depending upon the comfort level of the presenters and current COVID-19 status or other restrictions.

Some Benefits of In Our Own Voice:

For the presenter:

—Build confidence and pride in one’s experience and achievements

—Promote continued recovery

—Gain volunteer hours to use toward other certifications

—Enhance public speaking and storytelling skills

—Build a resume of appearances and references

—Change attitudes and assumptions about people with mental health conditions

—Know that you’re changing lives through sharing your experience

For the community:

—Increased program offerings to participants of recovery and wellness programs (as attendees or presenters)

—Increased program offerings to participants of work empowerment programs (as attendees or presenters)

—Public education events about living with mental health conditions

—An end to stigma around mental health conversations and care

—An introduction to free NAMI mental health support and education

If you know or are an adult with lived experience who would like to learn more or become an In Our Own Voice presenter, please email

Click here for more information about In Our Own Voice.

—By Beth McGee

Beth McGee is the executive director of NAMI Finger Lakes

Are Therapists Sufficiently Trained to Treat Suicidal Patients?

The headline of a USA Today article two years ago posed a troubling question: “We tell suicidal people to go to therapy. So why are therapists rarely trained in suicide?”

The article by Alia Dastagir noted that people experiencing suicidal thoughts are routinely advised, “See a therapist.” Yet, the article reported, “training for mental health practitioners who treat suicidal patients—psychologists, social workers, marriage and family therapists, among others—is dangerously inadequate.”

Dastagir quotes this concerning statement from Paul Quinnett, a clinical psychologist and founder of the QPR Institute, an organization that educates people on how to prevent suicide:

“Any profession’s ethical standards require that you not treat a problem you don’t know, and yet every day thousands of untrained service providers see thousands of suicidal patients and perform uninformed interventions.”

READ MORE: Training Tompkins Clinicians in Suicide Prevention

USA Today noted that no national standards require mental health professionals to be trained in how to treat suicidal people, either during their education or in their career; and only nine states mandate training in suicide assessment, treatment, and management for health professionals.

A survey for “Suicide Prevention and the Clinical Workforce: Guidelines for Training,” a 2014 task force report by the National Action Alliance for Suicide Prevention, found that only 19 percent of responding institutions of higher education reported that their clinical degree programs required specific course work entirely about suicide prevention. Seventy-five of 80 state credentialing and licensing boards reported they did not require specific training in suicide prevention prior to initial licensure or certification, and all 80 said that there was no specific training requirement for continuing education in suicide prevention.

Clearly, much work needs to be done to prevent suicides, judging from death statistics. Suicide is the second leading cause of death among Americans aged 10-34 and the 10th leading cause of death overall. While rates for other causes of death have remained steady or declined, the U.S. suicide rate increased 35.2% from 1999 to 2018.

In 2009, Quinnett kickstarted a discussion among colleagues about inadequate clinical training in suicide prevention, which inspired the American Association of Suicidology (AAS) to set up a task force to study the issue.

It issued a damning report in 2012, declaring that “the lack of training required of mental health professionals regarding suicide has been an egregious, enduring oversight by the mental health disciplines… The current state of training within the mental health field indicates that accrediting bodies, licensing organizations, and training programs have not taken the numerous recommendations and calls to action seriously.”

The report said, in part:

“We establish that mental health professionals regularly encounter patients who are suicidal, that patient suicide occurs with some frequency even among patients who are seeking treatment or are currently in treatment, and that, despite the serious nature of these patient encounters, the typical training of mental health professionals in the assessment and management of suicidal patients has been, and remains, woefully inadequate.”

The report said that only the field of psychiatry seemed to be “attempting to ensure that their trainees are, at a minimum, exposed to the skills required to properly conduct a suicide risk assessment and address suicidality in treatment.”

The report cited Quinnett’s definition of competence in the field:

“The capacity to conduct [a] one-to-one assessment/intervention interview between a suicidal respondent in a telephonic or face-to-face setting in which the distressed person is thoroughly interviewed regarding current suicidal desire/ideation, capability, intent, reasons for dying, reasons for living, and especially suicide attempt plans, past attempts and protective factors. The interview leads to a risk stratification decision, risk mitigation intervention and a collaborative risk management/safety plan, inclusive of documentation of the assessment and interventions made and/or recommended.”

The AAS report noted the U.S. surgeon general’s “call to action” in 1999 for competency in suicide risk assessment and management, as well as the 2001 National Strategy for Suicide Prevention’s goals for improved graduate school training in suicide care and more suicide care recertification and licensing programs for mental health professions.

The report said that while some states mandate continuing education in topics such as ethics, “there is no similar requirement to ensure that mental health professionals are using current information to assess and treat suicidal patients.”

The report noted the irony that in some places school employees are required to take gatekeeper training to make referrals to mental health professionals for potentially at-risk youth but there is no such requirement for the mental health professionals. “It is incomprehensible that, in many states, a teacher is now required to have more training on suicide warning signs and risk factors than the mental health professionals to whom he or she is directing potentially suicidal students,” the report said.

READ MORE: New Plan for Preventing Suicides in Tompkins County

The task force said there are inherent dangers in referring suicidal people to mental health professionals who are not adequately trained. If these individuals do not feel they receive effective treatment, the report said, they may drop out, become discouraged about the usefulness of treatment, and become at even higher risk for suicide.

The task force made five recommendations “to ensure that mental health professionals are properly trained and competent in evaluating and managing suicidal patients, the most common behavioral emergency situation encountered in clinical practice.”

  1. Accrediting organizations must include suicide-specific education and skill acquisition as part of their requirements for postbaccalaureate degree program accreditation.
  2. State licensing boards must require suicide-specific continuing education as a requirement for the renewal of every mental health professional’s license.
  3. State and federal legislation should be enacted requiring health care systems and facilities receiving state or federal funds to show evidence that mental health professionals in their systems have had explicit training in suicide risk detection, assessment, management, treatment, and prevention.
  4. Accreditation and certification bodies for hospital and emergency department settings must verify that staff members have the requisite training in assessment and management of suicidal patients.
  5. Individuals without appropriate graduate or professional training and supervised experience should not be entrusted with the assessment and management of suicidal patients.

The Sophie Fund asked Quinnett on March 8 whether any progress had been made in implementing the recommendations in the decade since the report was issued.

“I am unaware of significant changes in the training of clinicians at the graduate level where It needs to happen. There are a few people here and there teaching a seminar or maybe one class in one school of social work or psychology, but to my knowledge any training to really prepare students for practice is offered only though postgraduate seminars, workshops, and proprietary offerings. Practitioners continue to behave as if they don’t need this training. Thus, the consumer, in my view, remains at avoidable risk.”