National Suicide Prevention Month may be ending on September 30, but the need to support people experiencing a mental health crisis is more urgent than ever.
After a dip in 2019 and 2020, the suicide rate in the United States increased nearly 4 percent in 2021—47,646 deaths, up from 45,979 in 2020, according to a new report from the U.S. Centers for Disease Control. The rate for people age 15-24 rose 7 percent. Overall suicide rates have risen more than 30 percent in the past two decades.
Some good news: Seeking help became easier in 2020, with the introduction of the 988 Suicide & Crisis Lifeline. 988 has been designated as a new three-digit dialing code, similar to the simple-to-remember public safety hotline number 911.
The Lifeline provides free and confidential support to people in suicidal crisis or emotional distress 24 hours a day, seven days a week, across the United States. You can also connect to the Lifeline if you are concerned about a loved one, friend, or colleague.
988 calls go to into a nearby crisis center, one of 200 across the country. When people call or text 988, or connect to chat online, they will be connected to trained counselors that are part of the Lifeline network. Trained counselors listen, understand how the caller’s problems are affecting them, provide support, and connect them to resources if necessary.
NOTE: The previous Lifeline phone number (1-800-273-8255) will always remain available to people in emotional distress or suicidal crisis.
The Lifeline has been proven to be effective. According to its administrator, numerous studies have shown that callers feel less suicidal, less depressed, less overwhelmed, and more hopeful after speaking with a Lifeline counselor. Calls to the Lifeline have soared 45 percent since 988 was introduced in July.
The Lifeline is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and administered by Vibrant Emotional Health.
Warning Signs for Suicide
Take a moment to review the warning signs for suicide, as provided by the American Foundation for Suicide Prevention (AFSP). Be sure to get help for yourself or others if you see the signs. You may save a life.
According to AFSP, something to look out for when concerned that a person may be suicidal is a change in behavior or the presence of entirely new behaviors. This is of sharpest concern if the new or changed behavior is related to a painful event, loss, or change. Most people who take their lives exhibit one or more warning signs, either through what they say or what they do.
Warning sign: Talk
If a person talks about:
Having no reason to live
Being a burden to others
Warning sign: Behavior
Behaviors that may signal risk, especially if related to a painful event, loss or change:
Increased use of alcohol or drugs
Looking for a way to end their lives, such as searching online for methods
Withdrawing from activities
Isolating from family and friends
Sleeping too much or too little
Visiting or calling people to say goodbye
Giving away prized possessions
Warning sign: Mood
People who are considering suicide often display one or more of the following moods:
Some 300 participants raised more than $60,000 in the 10th Annual Greater Ithaca Out of the Darkness Walk on September 10 organized by the American Foundation for Suicide Prevention’s Greater Central New York Chapter.
Ithaca Out of the Darkness Walk at Myers Park
The walk, which took place in Myers Park in Lansing on the edge of Cayuga Lake, is among 400 or so held across the country every year designed to raise awareness and collect funds for research, training, and programming. The walkers included many people who lost a loved one, friend, or colleague to suicide.
This year’s Greater Ithaca walk was held on World Suicide Prevention Day. September is Suicide Prevention Awareness Month. The event surpassed the chapter’s $55,000 goal by more than $5,000.
“Suicide is preventable, and suicide prevention begins with all of us,” event Co-Chair Crystal Howser said in remarks at the event.
“By showing up today, you are sending the message that mental health is as real as physical health,” she added. “You are sending the message that reaching out for help is the strong thing to do. You are showing others that suicide can no longer be swept under the rug.
“By showing up, you let others know they are not alone. Because of you, we can fight for a day when no one will die by suicide.”
Event Co-Chairs Crystal Howser and Amber Parker
Howser shared that she began her journey after losing her father to suicide in 1998, and has lost other loved ones since then.
“These are just a few of the reasons I will continue to fight, to give a voice to those that may have lost their own, to help those that have lost a loved one heal, and bring hope to each and every person I meet along the way,” Howser said.
She said that the walkers honored the memory of those lost to suicide. “I also want to acknowledge those of you who have suffered personally from suicidal thoughts,” she added. “We are so glad to have you here with us in this fight. Your presence and openness allow others to know they are not alone in their struggle.”
This year’s walk included teams from Maguire Automotive, Alpha Gamma Rho at Cornell University, Ithaca College Women’s Lacrosse, SVNTA National Honor Society, CrossFit Vertical, among others.
The walk was sponsored by:
CFCU Community Credit Union; The Strebel Planning Group’s Strebel Fund for Community Enrichment; Suicide Prevention & Crisis Service; Maguire Automotive; BorgWarner Inc.; Northeast Pizza and Bones; Ithaca Apartment Management/Solomon Organization LLC; Moore Family Farm; Cayuga Medical Center; Visions Federal Credit Union; Lansing Funeral Home; Cayuga Lake National Bank; Tioga State Bank Foundation; and Ongweoweh Corp.
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.
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.
Five Aprils ago, The Sophie Fund organized a meeting of community mental health stakeholders representing 18 governmental and non-profit organizations from Tompkins County, the City of Ithaca, and the campuses of Cornell University, Ithaca College, and Tompkins Cortland Community College.
Co-Founder Scott MacLeod introduced The Sophie Fund to the community, explaining that it was established in memory of his daughter who died by suicide in Ithaca the previous year, and outlining its mission to support mental health initiatives aiding young people in the greater Ithaca area.
Garra Lloyd-Lester, associate director of the Suicide Prevention Center New York, announced plans to convene a “key stakeholders” with the aim of establishing a suicide prevention coalition in Tompkins County.
At the close of the April 17, 2017 meeting, the assembled stakeholders adopted a solemn resolution. It was dubbed The Watershed Declaration, as the meeting was hosted by The Watershed, a new downtown watering hole owned by Sophie’s friend and former colleague.
The declaration reads:
“We the assembled mental health stakeholders of the greater Ithaca community and Tompkins County recognize suicide as a serious public health concern. Today we renew our commitment to suicide prevention and pledge to intensify efforts toward saving lives and bringing hope to those struggling with suicide thoughts or affected by suicide loss.”
How did that pledge turn out? The results are mixed.
Led by Tompkins County Mental Health Services, 40 local mental health leaders came together in July 2017 and launched the Tompkins County Suicide Prevention Coalition.
In October 2017, The Sophie Fund organized an expert briefing at the Statler Hotel for senior healthcare administrators throughout Tompkins County; the topic was the Zero Suicide Model, which is designed to improve suicide prevention measures in healthcare systems.
Eight months later, the Suicide Prevention Coalition adopted Zero Suicide as its policy; eight healthcare providers stepped up to declare themselves “Zero Suicide Champions,” pledging to explore implementation of the model. In July 2018, the county legislature unanimously passed a resolution to support Zero Suicide, calling on local healthcare and behavioral healthcare providers to follow the model’s systematic clinical approach to preventing suicides.
Coalition work toward drafting a strategic plan, creating a leadership team, expanding membership, conducting outreach, and following up on Zero Suicide implementation badly drifted in 2020; this was partly due to leadership transitions throughout the county’s healthcare agencies, as well as disruptions caused by the Covid-19 pandemic.
The coalition resumed monthly meetings in February 2021, elected Sally Manning of Racker as convener, and resumed work on a strategic plan.
In February 2022, then coalition 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.
The five-point plan calls for using data to inform suicide prevention strategies; advancing the Zero Suicide Model in healthcare; reducing suicide in the youth population; reducing access to lethal means; and advocating for policies and practices to prevent suicide. The coalition has formed work groups to drive efforts in all five areas.
For its part, The Sophie Fund re-launched its Zero Suicide Initiative with a series of presentations and trainings to reinvigorate work on the model 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; it was led by Tammy Weppelman, the State Suicide Prevention Coordinator at the Texas Health and Human Services Commission, and Mike Olson, the crisis program manager at My Health My Resources, an agency currently implementing the model in in Tarrant County, Texas.
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.
Finally, in June Jenna Heise of the Suicide Prevention Center of New York will return to Ithaca for a roundtable discussion with top healthcare leaders on Zero Suicide implementation progress.