Dear Parents: Sending kids off to college is an exciting experience. Naturally, our focus is on the wonderful opportunities they will have, as we look with pride upon their promising passage into adulthood. But these stressful times require parents to also fully grasp the serious mental health challenges their students may face, and be equipped to provide support.
What do parents need to know?
Though some may hide or downplay it, rates of depression and anxiety are high among college students. Many students carry suicidal thoughts. Sexual assault is prevalent among college students. Hazing violence as an initiation rite at fraternities and some student organizations is a serious problem. All of these conditions pose greater risks for students who arrive on campus already with a mental health disorder.
College psychological counseling centers are typically overwhelmed by demands for appointments, and navigating community mental health services and insurance coverage can exacerbate the stress.
In short, student mental health can be a complicated matter, and failing to deal with it adequately can lead to serious consequences.
The Sophie Fund has updated a guide to help parents—especially those whose children are attending college in Ithaca—better understand the challenges:
Top healthcare leaders in Tompkins County have agreed to form a steering committee to drive local implementation of the Zero Suicide Model, an emerging standard designed to save lives by closing gaps in the suicide care offered by and across healthcare providers.
The move came during “Zero Suicide Roundtable: A Discussion on Best Practices in Suicide Prevention with Tompkins County Healthcare Leaders,” hosted on July 20 at the Statler Hotel by The Sophie Fund and Tompkins County Mental Health Services.
The 13 roundtable participants represented Cayuga Medical Center, Guthrie Cortland Medical Center, Tompkins County Health Department, Tompkins County Mental Health Services, Family & Children’s Service of Ithaca, Suicide Prevention & Crisis Service, Cornell University, Tompkins Cortland Community College, and The Sophie Fund.
The leaders’ agreement is a step toward fulfilling Goal 2 of the Tompkins County Suicide Prevention Coalition’s 2022-2025 Strategic Plan, adopted last February, which calls for “quality improvement for suicide care in all Tompkins County healthcare and behavioral health settings.”
The strategic plan’s Objective 2.3 calls for the formation of a “Zero Suicide Work Group comprised of leading health and mental health providers to share ideas, experiences, and challenges, and lead collaborative, sustainable efforts to implement the Zero Suicide Model throughout Tompkins County.”
Harmony Ayers-Friedlander, deputy commissioner of Tompkins County Mental Health Services, introduced Heise to the gathering “as we renew our commitment to the implementation of the Zero Suicide Model in our community, within, and across, our healthcare settings.” She noted that the county’s Suicide Prevention Coalition was launched exactly five years earlier with the vision of “a community where no lives are lost to suicide.”
Addressing the healthcare leaders, Ayers-Friedlander added:
“Your presence here today serves as a reminder of just how important this work is. Zero Suicide works. Because it gives us hope that we can make a difference, direction through a systems-based framework when faced with the complexity of human suffering, and real tools that help us at each step of the way. Today is a time to evaluate where we are individually as institutions and collectively as a community in preventing suicide through this model.”
Jenna Heise, director of New York State’s Suicide Prevention Implementation, moderates a Zero Suicide leadership roundtable
Heise opened the roundtable with a brief overview of the Zero Suicide Model and then walked participants through a discussion on the model’s seven elements: leadership, training, screening and assessment, care planning, treatment, transition of care, and quality improvement.
“The foundational belief of Zero Suicide is that individuals in our care, on our watch, need not die by suicide, and that suicide is actually preventable for those in care,” Heise said. “The way that happens is that suicide prevention and suicide care become a core priority for health and behavioral health. We have not done a good job of that, frankly.”
“We need to have that leadership commitment,” Heise said. Under the model, she explained, a leadership commitment creates a “just culture” for suicide care that relies on systemic use of best practices rather than leaving suicide prevention to individual health workers.
“It has to be looked at as a systems problem,” she said. “For too long, we have left it to the crisis team or to one outstanding individual clinician or social worker, and our systems, or the newest person, the greenest person straight out of school, who had no schooling in suicide.”
Citing examples of successful implementation of Zero Suicide, such as in the Henry Ford Health System in Michigan, Heise added: “It is an aspirational goal but it is quite attainable. There are folks that have done this work and committed to it, and followed this framework in implementing the seven elements, and they have shown that you could significantly reduce the suicides, by rate and number, within your healthcare organization.”
Heise commended Tompkins County’s approach to creating a “safer suicide community, wrapped around health and behavioral healthcare, including partners on board like the health department, behavioral health, large health systems, universities, higher ed, and so forth. That’s where you start to really see impact, everybody speaking the same language, using the same tools, the same best practices, the same framework. This is very exciting.”
Participants shared their experiences with various aspects of suicide prevention measures within their systems. They noted the importance of cross-system coordination and integration for suicide care, the challenge of staffing, and a desire for greater suicide-specific training. Several participants noted their continuous quality improvement efforts in suicide care but said they did not follow the Zero Suicide Model per se.
The Sophie Fund provided participants with a packet of materials about the Zero Suicide Model and previous suicide prevention efforts that have been undertaken in Tompkins County. The packet included the following items:
The roundtable was the fifth and final session of a Zero Suicide initiative launched by The Sophie Fund last November. 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.
“Implementation of Zero Suicide,” a suicide prevention presentation for front line managers, on March 24 by Tammy Weppelman, State Suicide Prevention Coordinator at the Texas Health and Human Services Commission.
If you or someone you know feels the need to speak with a mental health professional, you can contact the National Suicide Prevention Lifeline by dialing 988 (or 1-800-273-8255), or contact the Crisis Text Line by texting HOME to 741-741.
The 16 trainees were taught how to connect people to appropriate resources, that there is no-one-size-fits-all approach to mental health, and about the vital role that culture plays in how people understand and recover from mental health problems.
According to Little, ongoing research provides evidence that the trainings improve people’s understanding of mental health and help combat the stigma that persists in society around these issues.
“County residents from a wide variety of backgrounds came together to learn and improve their confidence in providing support for the people in their lives,” Little said. “While learning about recognizing and responding to mental health concerns, trainees came together in lively conversation, bringing up real-life situations and learning from each others’ experiences.”
The Mental Health Association has trained 113 people in Mental Health First Aid so far in 2022, with more courses planned for the rest of the year.
For more information or to inquire about receiving training in Mental Health First Aid, contact Melanie Little, director of Education at the Mental Health Association: email@example.com or (607) 273 9250.
Mental health challenges are more common than ever. Are you concerned about a friend or family member? Do you want to gain confidence in talking about mental health? Do you want to know more about what to do in a crisis?
Join the Mental Health Association in Tompkins County for a free Mental Health First Aid training on Saturday, July 9, from 10 a.m. to 5 p.m.
Mental Health First Aid (MHFA) is a comprehensive course from the National Council for Mental Wellbeing that teaches participants how to identify, understand and respond to signs of mental illnesses and substance use disorders.
The training teaches the skills to reach out and provide initial help and support to an adult who may be developing a mental health or substance use problem or experiencing a crisis.
To receive certification, participants must attend for the full-day course, and complete a 2-hour self-paced pre-course. (For those without computer/internet access for the self-paced course, the Mental Health Association can provide space and a computer.)
This training is provided in partnership with The History Center in Tompkins County with financial support from The Sophie Fund.
• Common signs and symptoms of mental health challenges
• Common signs and symptoms of substance use challenges
• How to interact with a person in crisis
• How to connect a person with help
• Information on trauma and its impacts
MHFA teaches a five-step action plan for first aiders:
• A: Assess for risk of suicide or harm
• L: Listen nonjudgmentally
• G: Give reassurance and information
• E: Encourage appropriate professional help
• E: Encourage self-help and other support strategies
WHEN: Saturday July 9, 10 a.m. to 5 p.m. (with a break for lunch on your own)
WHERE: The History Center in Tompkins County, 110 N. Tioga Street (Ithaca Commons), Ithaca, NY 14850
TO REGISTER: Contact Melanie Little, Director of Education, at firstname.lastname@example.org or (607) 273-9250.
—By Melanie Little
Melanie Little is the Director of Education and a Certified Peer Specialist at the Mental Health Association in Tompkins County
Healthcare expert Virna Little highlights a paradox in suicide prevention. Most primary care providers believe that suicide prevention is part of their role, she says. Yet, she adds, most of them also lack training during their education or professional experience in how to prevent suicide deaths among their patients.
Little was the featured presenter on June 16 at “Zero Suicide: Best Practices for Primary Care,” an event hosted via Zoom by The Sophie Fund and attended by Tompkins County physicians and their practices.
Her presentation walked attendees through a series of Zero Suicide protocols, including screening patients for suicide risk, assessing at-risk patients to determine appropriate levels of onward referrals, and developing safety plans to keep patients from acting on suicidal urges.
Little is internationally recognized for her work on integrating primary care and behavioral health, developing sustainable integrated delivery systems, and suicide prevention. She is the chief operating officer and co-founder of Concert Health, a national organization providing behavioral health services to primary care providers. She has conducted Zero Suicide trainings for more than 3,000 primary care providers in 27 states, and has spoken at the White House on national suicide prevention strategies.
The Zero Suicide Model is a set of strategies and tools for suicide prevention in healthcare as well as behavioral health care systems. It holds that by closing gaps in care through quality improvement measures, suicide deaths for patients in health and behavioral health systems are preventable. It is endorsed by the U.S. surgeon general and the State of New York’s Office of Mental Health. It is also advocated by the Tompkins County Suicide Prevention Coalition, whose 2022-2025 strategic plan identifies implementing Zero Suicide in healthcare across the county as one of its five goals.
Little stressed that primary care settings can “really move the needle” in reducing suicides. About 46,000 Americans take their own lives each year. Suicide is the 10th leading cause of death in the United States, and the second leading cause for people between 10-34.
Little urged primary care practices to operate a care system for treating patients at risk for suicide just as they do for patients with other chronic illnesses such as diabetes or asthma. She cited data showing that most people who died by suicide had a primary care visit within a month of their death. She noted that healthcare regulatory bodies, such as The Joint Commission, are saying “Listen, you really have to think about how you care for your patients at risk for suicide.”
DOWNLOAD: Primary Care Toolkit for Suicide Prevention
Little started by explaining the need for everyone on a practice’s care team to be aware of patients who are assessed as being at risk of suicide.
She related the story of a young woman who died by suicide after phoning her doctor’s office to cancel three appointments. The staff member who took the calls was unaware that the patient had been flagged as a suicide risk so took no steps to raise an alarm about the cancellations.
Little said that providers often tell her that they don’t know what to do if a patient shares that they are thinking of suicide.
“There’s one thing that is really the most helpful for people, and anyone can do it regardless of your background, your discipline, how long you’ve been in the practice,” she said. “That’s to give someone hope. We can all give someone hope.”
“It could very well be the first time that they’ve talked about suicide, or ever told anyone that they were thinking about suicide,” she said. “And so we want to make sure that our initial response is something that is going to be incredibly helpful for people, and to make sure that they know this is a safe place.”
Not to be caught off guard or utter an inappropriate message, she advises providers to create their own “storage statements”—words they can quickly use to show a suicidal patient that their life matters and to give them hope.
“Thank you for telling me.”
“You’re really important to us here at the center.”
“Your life is really important to me. Your life matters to me.”
“I have hope for you. I can see how strong you are.”
DOWNLOAD: Mental Health Support and Crisis Services in Tompkins County
Little said she was sympathetic to providers who feel that they don’t have enough time with individual patients to address the complexity of someone presenting with a risk of suicide. But she argued that providers have to think about implementing the same system of care for suicide as they do for other chronic illnesses. For example, she said, that may mean moving on to the next patient but coming back later to speak with the suicidal patient again.
“It would be a beautiful day in primary care if people came in for just one thing, or they came in for what turned out to be the most important, or life threatening thing.”
Little shared a personal story of how her husband went to his doctor complaining about hearing loss. The provider routinely took his height, weight, temperature, and blood pressure, and then informed him, “Listen, I’m really concerned, your pressure is incredibly high. I’m, not sure you’re going to be able to go home.” Little said the visit turned into one completely focused on blood pressure rather than hearing loss.
For patients at risk of suicide, she said, “We do the same things. We stop. We get information. We ask some questions. And we figure out an alternate level of care if we need one, or an appropriate level of care. That’s the way to start to think about patients who are at risk for suicide.”
She noted that there is a spectrum of suicidality, and that it is important to refer patients to appropriate levels of care. She cautioned against automatic referrals to emergency departments, saying that this can in some cases exacerbate a patient’s mental health condition.
“I worked for 17 years in the Putnum Hospital emergency room in New York State,” she said. “There is no magic that happens there. Most people I actually did not admit because that was not the level of care that they needed. So we really want to think about assessing risk, which can and does happen every single day in primary care settings, and can happen for suicide just like it does for other chronic illnesses.”
Little highlighted the importance of developing safety plans for patients, likening them to the “stop, drop, and roll” drill that children learn about what steps to take if their clothes ever catch fire.
“The likelihood that we’re going catch on physical fire is not very high, but we all know what to do,” she said. “So I want you to know what to do in case you catch on emotional fire.”
She said the safety plan should include providing the at-risk individual with the number of the National Suicide Prevention Lifeline—988 or (800) 253-8255—and actually having them put the number in their phone on the spot. Little’s presentation cited the Stanley-Brown Safety Planning Intervention, in which providers work with patients to develop a six-part safety plan that lists the individual’s internal coping strategies, distraction strategies, people and professionals they can contact in a crisis, and lethal means restriction strategies.
Little explained that discussing restricted access to lethal means with their patients is a critical piece of the safety plan. For people at risk of suicide, keeping guns out of harms way, or having a pharmacy issue prescription medications in individual pill packs, can really save lives, she said.
Little said she also directs at-risk patients to tools such as the Now Matters Now website, which includes videos with real people explaining the skills they’ve learned for coping with suicidal thoughts.
Little said once the appointment is over, caring contacts are “incredibly helpful” for people. She said providers should send a text or an email saying “Really glad we had a chance to see you today, I’m looking forward to seeing you next week.”
Little recalled being approached by one of her patients at a grocery store. “This woman came up to me, she pulled my note out of her purse, and said, ‘Virna, I carry this with me. It’s helpful.’ Just knowing that somebody out there cared gave her hope. Don’t underestimate the value of giving somebody hope.”
In conclusion, Little stressed the need for primary care providers to manage patients at risk for suicide like they would those with other chronic illnesses.
“If I am having asthma, and I come into your practice, what do you do? You might give me a treatment. you would ask me questions about my medication in my history. You would ask me about environmental triggers. You would ask me about emotional triggers. You might give me some education around how to use a rescue inhaler. You might make a referral to someone to come out to my home, or to a pulmonologist. You might do an asthma action plan. And so, when you think about all of those steps that you would do, you do that routinely for lots of chronic illnesses. All of that would be incredibly applicable to someone who was at risk for suicide.”
Little’s event was the fourth in a series of five presentations and trainings on Zero Suicide that The Sophie Fund is providing to the Tompkins County healthcare community. In July, along with the Tompkins County Mental Health Services, The Sophie Fund will co-host “Zero Suicide Roundtable: A Discussion on Best Practices in Suicide Prevention with Tompkins County Healthcare Leaders.”
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 988 or 1-800-273-8255, or contact the Crisis Text Line by texting HOME to 741-741.