Jay Carruthers, director of the Suicide Prevention Center of New York, told a conference on September 30 that other counties in the state “could learn a lot” from suicide prevention efforts undertaken in Tompkins County.

Carruthers moderated a panel discussion at “Rooted in Action: Innovative Approaches for Rural Suicide Prevention,” the New York State Office of Mental Health’s annual suicide prevention conference held in Ithaca this year on September 29-30. It was attended by more than 300 public health officials, healthcare and behavioral health providers, educators, researchers, and advocates from across the state.

Tiffany Bloss, Harmony Ayers-Friedlander, Laura Sidari, Andreia de Lima, and Jay Carruthers

The session, “Implementing the Zero Suicide Model: the Tompkins County Experience,” featured four local leaders:

Andreia de Lima, Chief Medical Officer, Cayuga Health/Centralus Health; Laura Sidari, Program Director and Consulting Psychiatrist, Cayuga Integrated Behavioral Health; Tiffany Bloss, Executive Director, Suicide Prevention & Crisis Service of Tompkins County; and Harmony Ayers-Friedlander, Deputy Commissioner of Mental Health Services, Tompkins County Whole Health.

Carruthers kicked off the session explaining that Zero Suicide is a framework for “strengthening health systems in a systematic way to prevent suicides.” He said research shows that often people who die by suicide had just had contact with a health provider before their death. The model provides for a series of protocols to be used in healthcare and behavioral health, such as routinely screening patients for suicidality, assessing their level of risk, and providing brief interventions and suicide-specific, evidence-based treatment when indicated.

Carruthers commended local stakeholders for working together toward implementing the Zero Suicide model.

“Tompkins County really seems to stand out in many respects with its ability to work across different providers and organizations. I think that’s remarkable, and certainly other counties could learn a lot from the experience here in Tompkins,” Carruthers said.

New York State Suicide Prevention Conference, Ithaca, September 29

De Lima walked the session through the steps that Cayuga Health has taken toward implementing the model since 2017. She noted that her system’s initial steps were interrupted by the healthcare emergency caused by the Covid-19 pandemic in 2020 and 2021.

She explained that Cayuga Health’s initial Zero Suicide efforts were siloed in the hospital’s emergency department and the inpatient behavioral health unit. After Covid, leadership moved to expand the initiative to the entire health system, which includes primary care practices and addiction services besides the community hospital, she explained.

De Lima said Part 2 of Cayuga Health’s initiative began in 2023 with a presentation to senior staff by leading Zero Suicide expert Brian Ahmedani, Director of the Center for Health Policy & Health Services Research at Henry Ford Health in Detroit.

Cayuga Health proceeded with the steps in the model such as conducting an Organizational Self-Study and Workforce Survey and establishing an internal Zero Suicide steering committee and subcommitees. Cayuga Health clinicians are utilizing tools prescribed in the model including the PHQ-9 depression screen, Columbia C-SSRS assessment screen, and the Stanley-Brown Safety Plan intervention, de Lima said.

“[We want to] connect patients to the healthcare services that they need, and make this part of prevention, a natural part of your screening the same way we ask for risk factors for heart disease, for stroke, and for your high blood pressure. Mental health vital signs need to be part of it as well,” she said.

A major challenge Cayuga Health faces is providing Zero Suicide training to a workforce of 6,000 employees, including large units added with a recent merger, de Lima said. She said Cayuga Health is exploring ways that all employees can consistently receive continuing education in suicide prevention protocols and new employees can be trained during onboarding.

Sidari, a consulting psychiatrist embedded in primary case practices within Cayuga Health, called de Lima “an amazing champion” for bringing diverse units of the health system together behind the Zero Suicide initiative.

“Dr. de Lima was really instrumental in taking that to the next level, because as a chief medical officer, with the clinical background and the leadership background, she was able to connect us across this very siloed health system in ways that we would not have been able to despite how strongly and passionately we were about this,” she said.

Sidari said her experience as a psychiatrist within the U.S. Air Force’s suicide prevention program between 2008 and 2019 prepared her for supporting the Zero Suicide work at Cayuga Health.

“I experienced medicine and suicide prevention as part of a culture. It was from that robust background that I really had a good sense of how to develop processes and procedures in primary care because it was like the back of my hand from what I had done in the military, making that as part of the safety culture,” she explained.

Sidari shared how her military experience, including losing a mentor to suicide, highlighted the importance of socializing suicide prevention clinical work.

“When we’re looking at processes and looking at ways to serve, I always keep at the forefront those lived experiences of those that we work with. When somebody disclosed this thought of death by suicide, we need to express gratitude. The reality is 40 percent of people who die by suicide never tell anyone. But the majority have had a primary care visit. So the fact that that person is coming in today and has the courage to disclose, we want to honor that,” she said.

Suicide Prevention Center of New York team

Ayers-Friedlander, who oversees the county’s mental health serices and has played a leading role in the Tompkins County Suicide Prevention Coalition, emphasized the importance of driving the Zero Suicide initiative through broad community support and involvement. Besides benefitting from synergies, she noted, this supports specific elements of the Zero Suicide Model such as ensuring transition and continuity of care for suicidal patients.

“We know the point of care that has highest risk is when people are transitioning out of the hospital [after treatment for suicidality] and back into the community. We know statistically about half of those people are never showing up to your outpatient program. We’re working with the hospital right now trying to figure out how we improve that,” she said.

Ayers-Friedlander also stressed the importance of leadership in developing the Zero Suicide initiative.

“You need leadership at that very top level in your community, in your organizations. It has to be there if you’re going to implement this model. There are going to be challenges. If the top leadership says this is important and there’s buy in, but the people that have boots on the ground every day don’t understand why you’re doing this model, then it’s never going to go anywhere,” she said.

Ayers-Friedlander and other panelists cited The Sophie Fund’s role as advocate and coordinator in helping spur the Zero Suicide initiative.

Bloss, whose agency operates the 988 Suicide & Crisis Lifeline for 17 central New York counties and also provides training and education, lauded the county’s commitment.

“Tompkins County is like no other. The ways of collaboration, the grassroots here, is incredible. How well everyone works together and the buy-in that people have. You all are here because you care about suicide prevention. We want to know what else we can do. That’s the feeling that we need,” said Bloss.

She explained how her agency is instrumental in supporting continuity of care.

“People talking to 988, they are not able to get into their provider or they’re on a wait list for a therapy appointment. Usually when you leave the hospital you get a referral but doesn’t mean tomorrow. What do you do if something happens between now and then if it’s two weeks away? We’re able to be there to be able to be supportive for those folks,” she said.

Bloss noted that everyone has a role to play in preventing deaths by suicide, not just clinicians.

“Anybody who interacts with a human needs to have suicide prevention training. It is not just for the professional world. It can work in the exam room but it can also work in your living room. We need to be able to check the signs for people who are having signs of suicide and be comfortable asking the question so that we know what to do with the answer,” she said.

The panelists cited workforce turnover and shortages as major challenges in advancing the Zero Suicide initiative.

“One of the hardest things is when you lose staff that have been in a role, they’re well known in the community, a lynchpin position for communication across systems. That’s very challenging. And it takes a while to rebuild that gap. Unfortunately, in our field that happens quite a bit,” said Ayers-Friedlander.

“Then shortage is a significant problem. When people are doing more work than they should be doing, it’s very hard to say, ‘Oh, you should go to this committee. Don’t do a billable service during this hour ago, go to this committee and do this other thing.’ That sounds very nice but it gets very hard.”

De Lima also cited the challenge of finding and enabling champions within large, complex health systems to drive the implementation of Zero Suicide protocols.

“I was not the champion for this effort when it started. It came my way, and I embraced it. So you have to find someone that’s willing to do that. Many hands make for light work. It comes down to process and project management. I need someone that is my subject matter expert on X. And this is the community person. This is the hospital person. This is the primary care person,” she said.

In response to an audience question at the end of the session, de Lima injected a note of humility about meeting the challenges.

“Looking at the county and the health system and all the work that we have done together, in almost 10 years, we have done a lot. We can say this is great and still look forward to all the other things that need to happen,” she said.

The suicide prevention conference featured 18 breakout sessions in addition to several plenary sessions. Among other topics covered were suicide prevention programming in rural schools, supporting loss survivors, the role of faith leaders, firearms safety, and engaging rural veterans in mental health services. Vernon E. Davis II, an army veteran and comedian who has experienced suicidal thoughts, delivered the conference keynote address.

Ithaca Mayor Robert Cantelmo delivered welcoming remarks to the conference.

“This is an issue that is really important to me. Suicidal ideation is a real thing. And it is something that’s still, unfortunately, really taboo to talk about for a lot of folks, especially for our young people. Thank you all for the work that you do, for helping keep this in the sunlight, so that we can talk about these issues and reduce the prevalence of suicide,” he said.

OMH’s Suicide Prevention Center presented Madelyn Gould, professor emerita at the Columbia University Irving Medical Center, with the Frederick Meservey Life and Leadership Award honoring a New Yorker who has demonstrated extraordinary leadership in the field of suicide prevention. The Rural Suicide Prevention Advocacy Award was given to Elisa and Joseph Tobia. Sara Hults was presented with the Suicide Prevention Champion Award.

Madelyn Gould presented with the Frederick Meservey Life and Leadership Award

Elisa and Joseph Tobia presented with the Rural Suicide Prevention Advocacy Award

Sara Hults presented with the Suicide Prevention Champion Award