Tompkins County Adopts the Zero Suicide Model

The Tompkins County Legislature on Tuesday unanimously passed a resolution to support the Zero Suicide Model, calling on local healthcare and behavioral healthcare providers to follow the model’s systematic clinical approach to preventing suicides.

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Tompkins County Legislature July 17, 2018

“This is an initiative we can be proud of,” said Shawna Black, chair of the legislature’s Health and Human Services Committee, who sponsored the resolution. “We are going to be one of the first counties in New York State to implement Zero Suicide.”

“We have a lot of work to do as a county to support those that struggle with mental health issues,” Black added. “However, the conversation will continue and our goal of zero suicides will set the standard for our community and it’s providers. As a community we realize the need for honest conversation about suicide prevention and the tools we must implement in order to save lives. I would like to thank the many providers that offer service on a daily basis and for their commitment to the zero suicide initiative.”

The legislative passage of Resolution 7950 came a month after the newly formed Tompkins County Suicide Prevention Coalition voted overwhelmingly to recommend the Zero Suicide Model for healthcare providers as a countywide suicide prevention initiative.

Jay Carruthers, director of the New York State Office of Mental Health’s Suicide Prevention Office, commended the county’s efforts to implement Zero Suicide.

“The suicide prevention work done at the community level in Tompkins County over the last two to three years has been extraordinary,” Carruthers said in a statement to The Sophie Fund. “Creating community partnerships, raising awareness, decreasing stigma, forming a coalition, and most recently working to integrate suicide prevention in health and behavior healthcare services—the Zero Suicide Model—it’s a wonderful accomplishment.

“In fact,” Carruthers added, “a big topic of conversation at Governor Andrew Cuomo’s Suicide Prevention Task Force this year has been how to support robust suicide prevention at the local level. No one approach is going to be enough to materially reduce the number of suicides. It takes community-level public health approaches, a commitment to deliver suicide safer healthcare, and the creation a culture of data-informed programming. The partnership between Tompkins County and the state has been truly exemplary in moving in this direction.”

Sharon MacDougall, Tompkins County deputy commissioner of mental health services, said “the support from our community, the Tompkins County Health and Human Services Committee, and the Legislature is inspiring and incredibly meaningful to our behavioral health providers and clients. Tompkins County Mental Health Services is honored to collaborate with our partners to push forward a vision and commitment for Zero Suicide in our community.”

MacDougall noted that including Tompkins County Mental Health Services, a total of seven local healthcare providers have become “Zero Suicide Champions” by committing to implement the model: Cayuga Medical Center; Alcohol & Drug Council of Tompkins County; Suicide Prevention & Crisis Service; Cornell Health of Cornell University; Family & Children’s Service of Ithaca; and CAP Plan/Preferred.

David Shapiro, president and CEO of Family & Children’s Service, commented: “F&CS has for many years been at the forefront of suicide prevention in Tompkins County through the staff training, team support, and clinical supervision that have become hallmarks of our clinical program. F&CS is one of the founding members of the Tompkins County Suicide Prevention Coalition. Along with committing to the Zero Suicide Model, F&CS is also committed to be a Zero Suicide Champion and will share what we learn with the broader community so that we can all be better prepared to help people who may be at risk to commit suicide. Our commitment to the Zero Suicide Model sets a lofty goal with an aspirational challenge.”

Kent Bullis, executive director of Cornell Health, commented to The Sophie Fund: “Cornell Health supports the Zero Suicide model, and is committed to completing the Zero Suicide Organizational Self-Study this summer and reporting out our experience to the Tompkins County Suicide Prevention Coalition in the spring.”

In March, Cayuga Medical Center became the first major healthcare provider in Tompkins County to endorse the Zero Suicide initiative. “Cayuga Medical Center is committed to Zero Suicide and is currently studying what resources we need to implement,” David Evelyn, vice president for medical affairs, told The Sophie Fund. “We are pursuing the self-assessment.”

In comments to the Legislature prior to Tuesday’s vote, Scott MacLeod of The Sophie Fund said that “adopting the Zero Suicide Model is an important step in addressing the public health problem of suicide and the rising suicide rate.” The Sophie Fund sponsored The Watershed Declaration adopted exactly 15 months earlier in which local healthcare providers pledged to intensify suicide prevention efforts in Tompkins County. The Sophie Fund also co-hosted an expert briefing on the Zero Suicide Model last October at The Statler Hotel on the Cornell campus.

MacLeod thanked the Tompkins County Legislature and the Zero Suicide Champions for their support for the Zero Suicide Model. He also thanked and cited the valuable support provided by Jay Carruthers, director of the state Suicide Prevention Office; Associate Director Sigrid Pechenik; Garra Lloyd-Lester, associate director of the Suicide Prevention Center of New York State; and Michael Hogan, a former New York State mental health commissioner and a developer of the Zero Suicide Model.

The Tompkins County resolution reads in part:

WHEREAS, the Tompkins County Suicide Prevention Coalition endorses the Zero Suicide model as a framework for organizational commitment to safer suicide care in health and behavioral health care systems, and

WHEREAS, suicides are preventable, now therefore be it

RESOLVED, on recommendation of the Health and Human Services Committee, That Tompkins County hereby signs onto the Zero Suicide model to reduce the number of people committing suicides, commit to sharing lessons learned with other counties to support a state-wide initiative and encourage all health and behavioral healthcare to participate in the Zero Suicide model…

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Shawna Black (center), chair of the Health and Human Services Committee

The Zero Suicide Model, sometimes called the “Suicide Safer Care Model,” holds 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.

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.

As the Suicide Prevention Resource Center (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.”

The facts make a compelling case that healthcare settings must play a critical role in preventing suicide. 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 New York State 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.”

Zero Suicide is 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.”

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.

Grasping the Profound Pain of Suicide

Describing depression to those who haven’t experienced it can be clumsy. The analogy I’ve found that best embodies my experience is “cloudy days.” The sun is still there but I’m unable to access that light. Instead, I’m cold and muted. Sometimes it’s cloudy for so long it’s hard to remember what the sun looks like. Sometimes it’s hard to believe the sun is there at all.

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A sculpture from “Schism” representing Sophie Hack MacLeod

As someone who has battled depression for years and intimately understands the pain surrounding suicide and mental illness, I want my art to make a statement about this epidemic. Art is visceral and can describe an effect or experience in deeply powerful ways. This, and my drive to grow as an artist, pushed me to complete a minor in fine arts as an undergraduate at Cornell University.

My installation, “Schism,” is featured in Still I Rise, an exhibition curated by Laura Rowley with the work of 12 artists on view at the Tompkins County Public Library from July through September. “Schism” deals with the pain of losing loved ones to suicide, commenting on the profound hole the deaths leave behind. With rising mental health concerns among my generation, the ability to outwardly mourn for people who die by suicide is incredibly important along the path to healing.

Yes, suicide is a sensitive topic. No, this doesn’t mean we shouldn’t talk about it. Treating suicide as a taboo topic not only stunts the healing process for suicide loss survivors, but teaches those plagued with suicidal thoughts that it’s something to be ashamed of, a weakness, which can deter them from seeking support. Open and empathetic conversation is critical to combat such tragedy.

“Schism” contains three sculptures. Each is a life-size, wooden silhouette of a suicide victim that is painted black with the best runner up to Vantablack commercially available, Black 2.0. It’s a special paint that is meant to absorb a higher percentage of light, creating the visual effect of “a schism in space.” This is meant to convey the loss felt when someone is a victim to suicide, to reveal the hole that remains in their physical shape in space they inhabited in life.

This installation is designed to represent loss of the individual, as each sculpture is a personalized and unique silhouette. Further, it is intrinsically connected to Ithaca as the individuals represented were all affiliated with the area: Sophie Hack MacLeod, 23, a Cornell fine arts major; Jason J. Seymour, 40, a Cornell systems analyst; and Alexander Joseph Reposh, 25, an Ithaca filmmaker and musician.

When someone is having suicidal thoughts, it’s far too easy to think, “I don’t matter, no one will even miss me, what’s the point? It’s suffocating.” I hope that “Schism” can be a reminder to those experiencing suicidal thoughts that your life is not trivial but is something to be cherished. “Schism” is also a symbol for those mourning a loved one and the horrific loss they must cope with.

—By Brianna Evans

briannaBrianna Evans is a 2018 graduate of the College of Agriculture and Life Sciences at Cornell University. “Schism” was created as an independent study project supervised by Professor Roberto Bertoia of the College of Architecture, Art, and Planning. She wishes to thank The Sophie Fund, and the families of Sophie Hack MacLeod, Jason J. Seymour, and Alexander Joseph Reposh, for their support.

Well Done, Active Minds

An important new study indicates that student mental health organizations such as Active Minds on college campuses increase mental health knowledge, decrease stigma around mental disorders, and increase helping behaviors.

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Facebook photo of Active Minds members at Ithaca College

“Student peer organizations’ activities can improve college student mental health attitudes and perceived knowledge and significantly increase helping behaviors,” said the study, published this week in the Journal of the American Academy of Child & Adolescent Psychiatry. “Such organizations can complement more traditional programs and play an important role in improving the campus climate with respect to mental health.”

The study, titled “Strengthening College Students’ Mental Health Knowledge, Awareness, and Helping Behaviors: The Impact of Active Minds, a Peer Mental Health Organization,” surveyed more than 1,100 students during the 2016–17 academic year at 12 California colleges with Active Minds chapters.

A June 28 Washington Post story about the study cited the Active Minds chapter at Ithaca College, and it’s co-president, Zoe Howland:

“The rising senior at Ithaca College joined its chapter her freshman year and says the group made her transition easier. The New York school’s chapter is one of the oldest and largest in the country, averaging about 30 members a year. Among the activities they promote are ‘Speak Your Mind’ panels for which students are trained to tell their own mental-health stories or those of friends or family members. The panels visit classrooms and several times a year address the entire campus. ‘I came in not knowing what I wanted to do,’ said Howland, who is now the group’s co-president. ‘Now I want to go into mental-health advocacy. Active Minds ignited a passion in me that I didn’t know existed.’”

Executive Director Alison Malmon founded Active Minds in 2003 while at the University of Pennsylvania three years after the suicide of her 22-year-old brother Brian, a student on leave from Columbia University. The group has some 450 chapters and operates on more than 600 campuses across the country.

According to the study, student peer organizations conduct a range of activities “to lessen stigma, improve knowledge of mental health, and enhance skills for identifying and referring peers struggling with mental health issues.” Active Minds’ activities include campus installations such as “Send Silence Packing,” a display of more than 1,100 backpacks to represent the number of college students lost to suicide each year; speak-out events and storytelling programs; and discussion groups and and seminars. “These activities help promote an ongoing dialogue about mental health on campus through peer-to-peer conversations, social media, ongoing programming, and campus print media,” said the study.

The study concluded:

“These findings suggest that, in addition to more traditional education or contact-based programs that rely on short-term or singular experiences to reduce stigma and improve knowledge of mental health issues, student peer organizations that establish an on-going presence on campuses and use a combination of educational, contact-based, large-scale programs, and small-group activities initiated and led by peers on campus throughout the year can meaningfully influence not only student perceived knowledge and attitudes but also their behaviors within a single academic year.

“Such changes in how the general student population views and understands mental health issues, brought about by student peer organizations, could be instrumental in shaping a more supportive climate toward mental health issues on campus. This has important implications for addressing student mental health treatment needs, because students with mental health problems are more likely to receive needed services if they feel the climate on their college campus is more positive with respect to mental health.

“Increased familiarity with Active Minds over the school year, whether resulting from exposure to a range of on-campus activities (e.g. public exhibitions and interactive events) or simply general awareness of the organization, appears to have successfully raised perceived mental health knowledge and awareness and decreased stigma, regardless of whether students were actively involved in Active Minds programming. Furthermore, students who became actively involved with Active Minds during the academic year appear to be more likely to take action to support others with mental health issues, behavioral activation that is not commonly seen in many more traditional education or contact-based programs.”

The study noted that the work of campus organizations like Active Minds can potentially increase students’ use of mental health services, but added that there remains a critical need for “sufficient mental health services” to meet the needs of students. “Among college and university students in the United States,” the study said, “there is a substantial gap between the need for mental health treatment and the receipt of mental health services.”

According to the study:

“Recent studies estimate that 20% to 36% of college students deal with some form of serious psychological distress, but that only approximately a third of these students, many of whom have access to on-campus providers and insurance to cover services, receive treatment. This unmet need for mental health care among college students represents a significant public health issue. Young adulthood is a critical period: without treatment for mental health problems, students face a range of potentially serious and lasting consequences, including dropping out, substance misuse, difficulties with social relationships, and lower lifetime earning potential.”

The Fall 2015 National College Health Assessment, in a survey of 19,861 students at more than 40 American schools, reported that 35.3 percent “felt so depressed that it was difficult to function.”

According to the 2017 annual report of the Center for Collegiate Mental Health, data collected from 147 college counseling centers showed that 34.2 percent of 161,014 college students seeking counseling in the 2016–17 academic year had “seriously considered attempting suicide.” The rate increased for the seventh year in a row, up from 24 percent in the 2010-11 academic year. The data also showed that 10 percent of the students seeking counseling had actually made a suicide attempt.

For more information, go to the Active Minds website.

Finding Hope: Battling America’s Suicide Crisis

Watch Anderson Cooper’s CNN town hall, “Finding Hope: Battling America’s Suicide Crisis,” an excellent program exploring the risk factors for suicide, ways to reach out for help, and how to aid somebody who may be struggling.

The National Suicide Prevention Lifeline can be reached by dialing 1-800-273-8255. It provides free and confidential support 24 hours a day, seven days a week for people in suicidal crisis or distress, or for those who are helping a person in crisis.

The recent deaths of Kate Spade and Anthony Bourdain prompted a national conversation about suicide. Anderson Cooper’s Town Hall aired Sunday June 24 and featured the following guests who shared their expertise and experience of being touched by suicide:

Anderson Cooper, CNN anchor

Glenn Close and Jessie Close, actor and her sister

David Axelrod, former advisor to President Barack Obama

Karl Rove, former advisor to President George W. Bush

Christine Moutier, chief medical officer, American Foundation for Suicide Prevention

Talinda Bennington, widow of Linkin Park lead singer Chester Bennington, co-founder of 320 Changes Direction

Kirsten Powers, USA Today columnist

Randi Kaye, CNN reporter

Zak Williams, son actor and comedian Robin Williams

Jane Clementi, co-founder Tyler Clementi Foundation

James Hatch, former U.S. Navy SEALs member

Sanjay Gupta, neurosurgeon and CNN chief medical correspondent.

Jordan Burnham, Active Minds mental health advocate

Dese’Rae L. Stage, artist, public speaker, and suicide prevention activist, creator of Live Through This

Tompkins Coalition: “Yes” to Zero Suicide Model

The Tompkins County Suicide Prevention Coalition on Monday overwhelmingly voted to recommend the Zero Suicide Model for healthcare providers as a countywide suicide prevention initiative. Deputy Mental Health Services Commissioner Sharon MacDougall said the coalition’s recommendation will be sent to the Community Services Board and the Tompkins County Legislature for consideration.

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Deputy Tompkins County Mental Health Services Commissioner Sharon MacDougall (center) with Cornell University students Winnie Ho of Alpha Phi Omega Gamma Chapter and Sophie Jones of The Sophie Fund

Four healthcare organizations attending the meeting also announced their agreement to become Zero Suicide “champions”—Tompkins County Mental Health Services; Alcohol & Drug Council of Tompkins County; Cornell Health, the healthcare center of Cornell University; and Cayuga Area Plan/Preferred, Inc., which represents primary care providers. MacDougall asked the champions to “commit to the model and report back to this coalition next spring in 2019.” In March, the Cayuga Medical Center announced its adoption of the Zero Suicide Model.

Prior to the meeting, about 50 people attended a community presentation on the Zero Suicide Model given by Jillian King and Olivia Retallack of the New York State Office of Mental Health’s Suicide Prevention Office.

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The Zero Suicide Model holds that suicide prevention is 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. The model’s developers argue 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.”

King and Retallack called suicide “an enormous public health problem,” and noted that many people who take their own lives are receiving treatment in healthcare systems. According to data they presented, 80 percent of people who died by suicide had healthcare visits within the prior 12 months. And most had a recent visit: 45 percent had a primary care visit within a month of their deaths; and 19 percent had contact with mental health services within the past month.

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Inadequate training is part of the problem. In a 2014 survey of New York State mental health providers, 64 percent felt they had little or no specialized training for suicide intervention; 33 percent did not feel they had sufficient training to assist suicidal patients.

MacDougall recounted how Tompkins County Mental Health Services improved its suicide prevention efforts when it began adopting the Zero Suicide Model in 2016:

“What I realized was that we weren’t using evidence-based assessments or screening tools to ask the question. We were talking about depression. We were talking about things with our clients. But we didn’t actually use a specific screener, or a specific assessment that’s based on the best research available to ask the questions.

“So immediately we instituted C-SSRS [Columbia-Suicide Severity Rating Scale], it’s an evidence-based screening tool that you can use for everyone. And we use it for everyone who walks in our door for an intake, and we use it on a regular basis for anyone who is even coming close to discussing suicide or depression issues. That was one step we made from that first year.

“We also looked at the fact that we weren’t doing safety plans. We were doing an older version, like a recovery plan, or a plan of care, but not a true safety plan. So we use that on anybody who tests positive after asking the suicide assessment.

“The third thing we realized was that our staff wanted and needed more training. They were asking for more training. All of our staff completed online certification training on online webinars.

“Early progress from this is that I think we have staff who are far more trained and much better at identifying and engaging clients who have suicide [thoughts]. We actually just ask the question now. It’s not just the depression screening. We actually ask ‘Are you feeling suicidal?’ And we actually dig in deeper.”

The Sophie Fund, which sponsored The Watershed Declaration in April 2017 calling for intensified suicide prevention efforts in Tompkins County,  released a statement Monday following the coalition’s meeting:

“The Sophie Fund would like to thank the Tompkins County Suicide Prevention Coalition for supporting the Zero Suicide initiative. There are many agencies and individuals to acknowledge for their leadership, but we’d like to particularly thank Frank Kruppa and Sharon MacDougall of the Tompkins County Mental Health Services; Lee-Ellen Marvin of the Suicide Prevention & Crisis Service; and the Cayuga Medical Center, for its recent adoption of the Zero Suicide Model.

“We must do more to prevent suicide in Tompkins County. The Zero Suicide Model is an essential approach for saving lives. As the next step, The Sophie Fund renews its call on all the leading community and campus healthcare agencies in Tompkins County to commit to the Zero Suicide Model and to begin the implementation process as expeditiously as possible.

“We are experiencing a mental health crisis in the United States—and we must step up to meet that challenge. A terrible part of that crisis is the alarming rise in suicides. Just this month, the Centers for Disease Control and Prevention released a report that the national suicide rate increased 25.4 percent from 1999 to 2016. There are more than 1 million suicide attempts every year. It is the second leading cause of death among young people 15-24 years of age.”