Our Goal: Zero Suicide for Tompkins County

The Sophie Fund recently organized a small conference with a big purpose: to introduce and implement the Zero Suicide Model in Tompkins County. Together with Ithaca’s Suicide Prevention & Crisis Service and the New York State Suicide Prevention Office, we invited the most senior healthcare leaders from local government, medical centers, and college campuses to attend an expert briefing on October 16 at The Statler Hotel.

Zero Suicide briefing 101617

Healthcare leaders from Ithaca and Tompkins County

The presenters were two of the nation’s leading authorities on suicide prevention:

—Michael Hogan, a developer of the Zero Suicide Model, who served as New York State Mental Health Commissioner (2007–2012), Ohio Department of Mental Health Director (1991–2007) and Connecticut Mental Health Commissioner (1987–1991).

—Sigrid Pechenik, Associate Director of the New York State Suicide Prevention Office.

Turnout for the briefing was excellent. Attendees included: Tompkins County Public Health Director Frank Kruppa, who also serves as the county’s Mental Health Commissioner; Deputy Mental Health Commissioner Sharon MacDougall; senior administrators from Cayuga Medical Center and Family & Children’s Service of Ithaca; and health directors from Cornell University, Ithaca College, and Tompkins Cortland Community College.

Suicide is absolutely not an inevitable outcome for people struggling with suicide ideation related to mental illness or other factors. The Suicide Prevention Resource Center argues that “we all have a role to play” in preventing suicide.

The American Foundation for Suicide Prevention explains that “suicide most often occurs when stressors exceed current coping abilities of someone suffering from a mental health condition”—and part of the problem is that conditions like depression often go undiagnosed or untreated.

AFSP outlines the risk factors and warning signs for suicide, and the critical steps that suicidal individuals and their families and friends can take when such factors and signs are present. Risk factors include mental health conditions, stressful life events, and a family history of suicide. Warning signs include talking about pain and suicide, increased alcohol or drug use, withdrawing from family and friends, and exhibiting anxiety or loss of interest.

The Zero Suicide Model, sometimes called the “Suicide Safer Care Model,” goes further. Zero Suicide argues that suicides can be prevented by closing cracks in healthcare systems—that “suicide deaths for individuals under care within health and behavioral health systems are preventable.”

As Hogan and Pechenik emphasized in their Statler presentations, Zero Suicide means making suicide prevention a core responsibility of healthcare. Specifically, this entails a systematic clinical approach in healthcare systems—training staff, screening for suicide ideation, utilizing evidence-based interventions, mandating continuous quality improvement, treating suicidality as a presenting problem—and not simply relying on the heroic efforts of crisis staff and individual clinicians.

PechenikHogan

Sigrid Pechenik, Associate Director, New York State Suicide Prevention Office, and Michael Hogan, former New York State Mental Health Commissioner

As SPRC puts it: “The programmatic approach of Zero Suicide is based on the realization that suicidal individuals often fall through multiple cracks in a fragmented and sometimes distracted healthcare system, and on the premise that a systematic approach to quality improvement is necessary.”

Certainly, the facts make a compelling case that healthcare settings must play a critical role in preventing suicide. According to Pechenik, a review of New York State data of 3,564 suicides in 2013–2014 identified that 25 percent of the individuals who took their own lives had been discharged from emergency departments or inpatient facilities within just seven days prior to their suicide deaths.

The data also indicates a strong need to better train clinicians in suicide screening, assessment, intervention, and follow-up. Of 1,585 mental health providers surveyed by the NYS Office of Mental Health in 2014, 64 percent reported little or no specialized training in suicide-specific interventions. Moreover, about 33 percent reported that they did not feel they had sufficient training to assist suicidal patients.

Zero Suicide is at the heart of the 2012 National Strategy for Suicide Prevention, released by the U.S. Surgeon General and the National Action Alliance for Suicide Prevention. The NSSP’s Goal 8 is to “promote suicide prevention as a core component of healthcare services.” Goal 9 is to “promote and implement effective clinical and professional practices for assessing and treating those at risk for suicidal behaviors.”

As Pechenik noted, Zero Suicide is also explicitly embraced by the NYS Suicide Prevention Plan 2016–17, entitled 1,700 Too Many. Implementing Zero Suicide in health and behavioral healthcare settings is the first pillar of the suicide prevention strategy outlined in the plan. The second pillar is to “create and strengthen suicide safer communities.”

According to the U.S. Substance Abuse and Mental Health Services Administration, “There is strong evidence that a comprehensive public health approach is effective in reducing suicide rates.”

Hogan pointed out that the Zero Suicide Model builds on breakthroughs such as the Perfect Depression Care Initiative implemented in 2001 by the Henry Ford Health System in Michigan. Its comprehensive approach to mental and behavioral healthcare—incorporating suicide prevention as an explicit goal—demonstrated a 75 percent reduction in the suicide rate among Henry Ford health plan members.

More recently, Hogan highlighted, The Joint Commission issued a Sentinel Event Alert on the imperative of improving suicide prevention in healthcare settings. The Alert is important because the commission is a body that accredits and certifies nearly 21,000 healthcare organizations and programs (including Cayuga Medical Center) across the country—such accreditation and certification is a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

The Joint Commission’s February 24, 2016 Sentinel Event Alert Issue 56, entitled “Detecting and Treating Suicide Ideation in All Settings,” stated:

“The Joint Commission urges all healthcare organizations to develop clinical environment readiness by identifying, developing and integrating comprehensive behavioral health, primary care and community resources to assure continuity of care for individuals at risk for suicide.”

The Sentinel Event Alert recommended detailed actions for suicide ideation detection; the screening, risk assessment, safety, treatment, discharge, and follow-up care of at-risk individuals; educating all staff about suicide risk; keeping health care environments safe for individuals at risk for suicide; and documenting their care.

The commission’s focus on suicide prevention in healthcare settings stems from the belief that while being alert to risk factors and warning signs is important, it is not sufficient. There is no typical suicide victim: most people with risk factors don’t attempt suicide, and others without risk factors do. Thus, the Alert stated:

“It’s imperative for healthcare providers in all settings to better detect suicide ideation in patients, and to take appropriate steps for their safety and/or refer these patients to an appropriate provider for screening, risk assessment, and treatment.”

The Alert reported that many communities and healthcare organizations presently do not have adequate suicide prevention resources, leading to the low detection and treatment rate of those at risk. It noted that although most people who die by suicide receive healthcare services in the year prior to their deaths, healthcare providers often do not detect their suicidal thoughts. “Supportive continuity of care for those identified as at risk for suicide is crucial,” the Alert said.

The Joint Commission reported that in 2014 many commission-accredited organizations were actually rated non-compliant with its National Patient Safety Goal 15.01.01 Element of Performance 1: “Conduct a risk assessment that identifies specific patient characteristics and environmental features that may increase or decrease the risk for suicide.”

The commission said its database recorded 1,089 suicides occurring from 2010 to 2014 among patients receiving care, treatment, and services in a staffed, around-the clock care setting or within 72 hours of discharge, including from a hospital’s emergency department. According to the Alert, “The most common root cause documented during this time period was shortcomings in assessment, most commonly psychiatric assessment.”

The Joint Commission said its Sentinel Event Alert aimed “to assist all healthcare organizations providing both inpatient and outpatient care to better identify and treat individuals with suicide ideation.” The Alert listed areas for improvement:

—Clinicians in emergency, primary, and behavioral healthcare settings particularly have a crucial role in detecting suicide ideation and assuring appropriate evaluation.

—Behavioral health professionals play an additional important role in providing evidence-based treatment and follow-up care.

—For all clinicians working with patients with suicide ideation, care transitions are very important. Many patients at risk for suicide do not receive outpatient behavioral treatment in a timely fashion following discharge from emergency departments and inpatient psychiatric settings.

The Sentinel Event Alert noted that suicide is the 10th leading cause of death in the United States, taking “more lives than traffic accidents and more than twice as many as homicides.” In 2011, according to data published by the U.S. Centers for Disease Control, suicide became the second leading cause of death for Americans aged 15-24.

In April 2016, the National Center for Health Statistics reported a 24 percent increase in the suicide rate in the United States from 1999 to 2014. While age-adjusted death rates for heart disease and cancer have dramatically declined in the last two decades thanks to improved detection and treatment strategies, the suicide rate has skyrocketed.

On September 15, 2017, the U.S. National Institute of Mental Health reported that three interventions, which were designed for follow-up of patients identified with suicide risk in hospital emergency departments, save lives and are even more cost effective than usual care. The interventions were sending postcards to patients at risk; calling discharged patients to offer support and encourage follow-up treatment; and connecting patients to suicide-focused cognitive behavioral therapy programs.

“In the face of a gradually rising suicide rate, the need for effective prevention strategies is urgent,” said NIMH Director Joshua Gordon. “These findings of cost-effectiveness add to the impetus for implementing these life-saving approaches. Importantly, they also make a strong case for expanding screening, which would allow us to reaching many more of those at risk with life-saving interventions.”

statler

It is the hope of The Sophie Fund that the October 16 briefing at The Statler Hotel is the start of a process of garnering commitments from local healthcare leaders to develop implementation plans that bring the Zero Suicide Model to Tompkins County.

To achieve ultimate success, “buy-ins” will be needed from major healthcare systems including psychiatric units, emergency departments, and college health centers, as well as from primary care providers and substance use disorder treatment centers.

To assist healthcare organizations in implementing the seven fundamentals of Zero Suicide, SPRC established the Zero Suicide project offering online resources such as an organizational self-study, implementation toolkits, readings, and webinars, and an offline Zero Suicide Academy providing two-day trainings for healthcare leadership.

The NYS Office of Mental Health operates the New York Academy for Suicide Safer Care, which offers a 9-12 month program of webinars and coaching calls for organizations seeking to raise their standard of suicide care.

The Statler briefing follows several encouraging local developments in suicide prevention during 2017.

On April 17, community mental health stakeholders representing 18 organizations adopted The Watershed Declaration, calling suicide a “serious public health concern” and pledging to intensify suicide prevention efforts in Ithaca and Tompkins County.

On June 7, 2017, Ithaca Mayor Svante Myrick issued a proclamation supporting The Watershed Declaration and calling for “an all-out effort to prevent suicide.” The Tompkins County Legislature issued a similar proclamation on September 5, 2017.

On July 31, led by the Tompkins County Department of Mental Health, local mental health leaders launched the Tompkins County Suicide Prevention Coalition representing 32 organizations including health, behavioral health and substance use disorder treatment facilities, schools, and county departments.

—By Scott MacLeod and Susan Hack

Scott MacLeod and Susan Hack are officers of The Sophie Fund, Inc., a nonprofit charitable corporation supporting mental health initiatives aiding young people in greater Ithaca and Tompkins County.

A Concert for Mental Health… and Hope

Ithaca College’s music students and faculty staged an unforgettable show featuring Broadway hits, old favorites, and even a Handel aria Tuesday evening November 14 in “Music for the Mind: Mental Health Awareness Concert.”

The event in Ford Hall at the Whalen School of Music was the brainchild of Megan Jones, a junior voice student, who was inspired to “do something” after a fellow student and dorm mate attempted suicide earlier this year. The Ithaca College community quickly rallied to the cause.

“Nobody should feel as alone as my dear friend did, and I so strongly believe that music is a perfect way to bring attention, raise awareness, and comfort anyone around to hear it,” Megan told The Sophie Fund.

“Music for the Mind” was a tour de force showcasing IC’s exceptional instrumental, voice, and dance talent in nine musical pieces, including “Make Someone Happy,” “Somewhere Over the Rainbow,” “Rise Up,” “Lascia Chio Pianga,” “Please Stay,” “You’ll Never Walk Alone,” and “You Will be Found.”

“A strength of the Ithaca College community is our care for one another,” Deborah Harper, director of IC’s Center for Counseling, Health and Wellness, said in opening remarks to the audience. “What you are about to experience is one example of care in action. Music uplifts us, soothes us, inspires us, invites us to feel deeply. I would like to thank Megan for bringing her vision—’Music for the Mind’—to life tonight. As we spend the next hour together, I want to invite you to reflect on the value of our connections to life and to the people we hold dear. Open yourself to the music and allow your heart and mind to be moved.”

Before the curtain rose, Megan Jones introduced her friend Lola, who spoke eloquently and powerfully about her experience, and addressed others “who might be struggling right now”:

“This concert is for you. You might be used to being spoken around. For people to slightly touch the subject of your life, and just as quickly to draw back. For people to talk to the helpers instead of the people who need help.

“I am not you. Your symptoms are yours. You are your own person. But also you are not alone. All in all, you aren’t. You are a human in a world full of humans. You are not going crazy. You are suffering from an illness. You are living through it. You’re doing the best you can, and that really is enough. I don’t know you or what you are going through, but I know you can get through it. You’re strong, you’re trying, you’re alive, you’re here.

“Your disorder or illness is not just an excuse. You are more than enough. It may take a while to get out of this funk. It may just be something you deal with forever. But you will overall get better. You will learn to cope better. You will make friends. You will lose friends. It might be hard. You’ll continue to learn and you’ll continue to grow. One day, I truly think, the good days will start to outweigh the bad.

“Remember that people can’t know what you are going through until you tell them. That’s still something I’m trying to learn and get used to. You need to learn to take care of yourself at the end of the day.”

Click here to watch the “Music for the Mind” concert

Photos by Sarah Horbacewicz

[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.]

1-pleasestay1

“Please Stay,” by Jake Runstad. Performed by the Ithaca College Choir, directed by Janet Galván, professor of performance studies.

 

0-pleasestay2

“Please Stay,” by Jake Runstad. Performed by the Ithaca College Choir, directed by Janet Galván, professor of performance studies.

 

2-dearevanhansen

“You Will be Found,” from Dear Evan Hansen, by Benj Pasek and Justin Paul.

 

3-riseup

“Rise Up,” by Andra Day. Performed by Laurel Albinder and IC Voicestream.

 

4-MyOhMy

“My Oh My,” by Punch Brothers. Performed by Jonah Bobo, John Bourdelais, Tom Brody, Marybeth MacKay, and Nicky Young

 

5-DeborahMontegromeryCove

“You’ll Never Walk Alone,” from Carousel by Richard Rodgers and Oscar Hammerstein. Performed by Deborah Montgomery-Cove, professor of performance studies.

 

6-findinghope

“Finding Hope,” by Ava Maria Safai. Performed by the IC Unbound Dance Company.

 

8-Lascia chio pianga3

“Lascia Chio Pianga,” from Rinaldo, by George Frideric Handel. Performed by Ivy Walz, associate professor of performance studies, with string quartet and dancers.

 

7-Lascia chio pianga

“Lascia Chio Pianga,” from Rinaldo, by George Frideric Handel. Performed by Ivy Walz, associate professor of performance studies, with string quartet and dancers.

 

9-marcwebster

“Make Someone Happy,” by Jule Styne. Performed by Marc Webster, assistant professor of performance studies, (with Megan Jones and Christopher Zemliauskas).

 

10-MeganJones

“Make Someone Happy,” by Jule Styne. Performed by Megan Jones, IC voice student, (with Marc Webster and Christopher Zemliauskas).

Even Polo Players Get the Blues

Cornell University’s Varsity Polo Team is an outstanding example of how each one of us can play a vital role in promoting mental health. For the fifth year in a row this Saturday, October 28, the team is playing a benefit match to raise awareness and collect donations for suicide prevention.

2017_Benefit_Match_Poster

The fitting tagline for this year’s benefit match is “Even Polo Players Get the Blues.” Members of the Cornell equestrian team created the annual event in memory of Sue Knight (’81), captain of Cornell championship teams in 1980 and 1981. Knight died by suicide after a long battle with depression in early January 2013 at age 53.

“This cause is especially important to Cornell polo team members both past and present as we lost a beloved former women’s team player and team captain far too soon,” said Anthony Condo, Jr., a Cornell volunteer coach. “In short, it is real close to home for so many of us.”

The benefit match is a day of weekend fun, with spectators taking in the match, watching a demonstration of polo skills, and meeting members of the Cornell team. The event starts at 2 p.m. at the John T. Oxley Equestrian Center in Ithaca. Parking and admission are free.

Donations collected will be directed to the American Foundation for Suicide Prevention, a national organization devoted to new research, educational programs, advocacy for public policy, and supporting survivors of suicide loss.

Click here to make a donation to AFSP anytime.

[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.]

Cornell polo team members

Caption: Cornell polo coaches and team members celebrating an Amateur Cup victory, August 2017.

“It Affects People We Just Really Love”

Not very long ago, there was a debilitating stigma around breast cancer. After Julia Louis-Dreyfus’s quick and public announcement this week revealing that she has been diagnosed with breast cancer, USA Today published a great piece tracing how the stigma has been largely overcome. Are there some lessons here for breaking the stigma around mental health? Let’s hope so!

 

semicolon

Looking at “some of the big moments that took breast cancer out of the dark and into the pink,” the article starts with Terese Lasser, “the very first true activist… who bumped against the system.” Lasser questioned her surgeon’s indifference, and eventually formed the Reach to Recovery program to support women coping with breast cancer.

Perhaps we need more Terese Lassers bumping “against the system” in mental health.

The article cites a “huge event”—when then-First Lady Betty Ford announced publicly, in 1974, that she had breast cancer.

Thankfully, more and more public figures are “going public” with their mental health struggles. But more often than not, these testimonials are either overlooked by the media, or overshadowed by coverage of behaviors related to the public figures’ disorders.

The article reports on how in 1982 Nancy Brinker founded the first organization to target fundraising for breast cancer research, the Susan G. Komen Breast Cancer Foundation. In 2015, Susan G. Komen, just one of many organizations doing this work, reported revenue of $118.4 million. One in 8 women get breast cancer.

Mental health advocates must find more effective ways to fund mental health research. By contrast, the American Foundation for Suicide Prevention in 2015 raised less than one-fifth of that—$19.4 million—for its research and advocacy programs. An important organization dealing more broadly with mental health research, the Child Mind Institute, pulled in $11.2 million. An estimated 1 in 5 Americans experienced mental illness in 2015.

USA Today notes how more women were elected to Congress in 1992, and some of them took up the breast cancer cause (including some with personal family experience).

Former Republican Senator Gordan H. Smith of Utah was one such champion for mental health in Congress. After his son died by suicide at age 21 in 2003, Smith pushed for passage of the Garrett Lee Smith Memorial Act. It has provided millions in government funds for suicide prevention projects across the nation.

Explaining the success of the fight against breast cancer, a spokesman for the Susan H. Komen foundation remarked: “It affects people we just really love. Our moms and our daughters. Our grandmothers and our sisters. And in some cases our dads.”

Mental illness, too, affects people we just really love.

Caption: The semicolon is a symbol of suicide prevention, the brainchild of Project Semicolon whose slogan holds that “your story isn’t over yet.”

The Great Ithaca Cupcake Bake Off

Warm up your ovens! The 2nd Annual Ithaca Cupcake Baking Contest will be held in the Commons on Saturday October 14.

social-media-main

Contestants of all ages are invited to enter their tasty masterpieces, which will be eligible for more than $500 in prizes. The contest is open to amateur bakers only.

The contest is organized by The Sophie Fund, which was established in 2016 in memory of Cornell University art student Sophie Hack MacLeod to support mental health initiatives aiding young people.

The 2nd Annual Ithaca Cupcake Baking Contest is sponsored by the GreenStar Natural Foods Market, Alternatives Federal Credit Union, and La Tourelle Hotel, Bistro and Spa. It is also supported by Waffle Frolic, Active Minds of Ithaca College, and Alpha Phi Omega, Phi Sigma Pi and Cornell Minds Matter of Cornell University.

Sophie’s own longstanding passion for baking and cupcakes inspired the launch of the contest. At the time of her death by suicide at age 23, while on a medical leave of absence from Cornell, Sophie was active in Ithaca’s vibrant culinary scene. According to her family, she hoped to open her own bakery after completing her Cornell degree.

To enter the cupcake contest, entrants are asked to bring their submissions to the Bernie Milton Pavilion in the Ithaca Commons from 10–11:30 a.m. on Saturday October 14. The winners will be announced and prizes awarded at a ceremony in the Pavilion later the same day at 3 p.m.

Last year, 57 contestants participated in the bake off, with Monica Lee Cotto taking home the top prize with a pumpkin cheesecake cupcake, set in a chocolate cage and topped with a confectionery yellow and coral rose and a butterfly crisp. The Best Youth Award went to 9-year-old Natalie McCaskill-Myers, who submitted a batch of lemon cherry cupcakes laced with lavender.

Sophie was born in Johannesburg and spent her childhood living in South Africa, then France, and eventually Egypt. But she adopted Ithaca as her hometown, spending five summers in the violin program of the Suzuki Institutes at Ithaca College and then enrolling at Cornell in 2010.

In conjunction with the contest, The Sophie Fund is organizing a fundraising campaign, with monies donated to suicide prevention causes in Ithaca and Tompkins County.

Click here for all the information on contest procedures and rules, and to download a registration form.