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.

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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.

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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.”

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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.

It’s Watershed Declaration Month

The Tompkins County Legislature on Tuesday proclaimed September 2017 to be “The Watershed Declaration Month” in support of intensified suicide prevention efforts in the community.

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In a proclamation read out in the name of legislature Chair Michael E. Lane, Legislator Anna Kelles said:

“I call upon our citizens, government agencies, non-governmental organizations, health care providers, and educational institutions to raise awareness of Ithaca’s mental health support services, encourage those in need to seek treatment, honor those in our community we have lost too soon, commit to an all-out effort to prevent suicide, and support the efforts of the Tompkins County Suicide Prevention Coalition.”

The proclamation came at the start of national Suicide Prevention Month and six weeks after the launch of the Tompkins County Suicide Prevention Coalition by 32 local mental health organizations. The Watershed Declaration was adopted at a meeting of mental health stakeholders in Ithaca on April 17. The organizations declared suicide to be a serious public health concern and pledged to “intensify efforts toward saving lives and bringing hope to those struggling with suicide thoughts or affected by suicide loss.”

In receiving the proclamation, Scott MacLeod, a donor advisor of The Sophie Fund, established to support mental health initiatives for young people in the community, thanked Kelles and the legislature for their support. He also commended the initiative of Tompkins County Mental Health Commissioner Frank Kruppa and Deputy Commissioner Sharon MacDougall to establish the county’s Suicide Prevention Coalition.

“We learned the hard way that suicide is a terrible tragedy, and we learned the hard way that suicide is preventable,” said MacLeod, whose daughter Sophie, a 23-year-old Cornell University student on a mental health leave of absence, died by suicide in March 2016. “We are convinced that promoting greater awareness of risk factors and warning signs—and with the role that healthcare systems can play in closing the gaps—can really save a lot of lives. One life is too many to lose, and we are losing too many.”

Lee-Ellen Marvin, executive director of the Suicide Prevention and Crisis Service in Ithaca, lauded the legislature’s designation of The Watershed Declaration Month. “It’s exciting to see people from all different sectors, the government and the non-profit community, coming together to re-enlist effort and energy in suicide prevention,” she said. “If we are going to make change in how suicide is understood and treated, and if we are going to register it as a public health crisis, we need governmental bodies to stand behind us.”

Kelles, chair of the county legislature’s Health and Human Services Committee, said The Sophie Fund’s push for The Watershed Declaration and Tompkins County Suicide Prevention Coalition “were both critical first steps in our community engagement to reduce deaths from suicide.”

“These are first steps on a long road to a very attainable goal that needs engagement from everyone in the community,” Kelles added. “We have a very fast paced lifestyle as a society where productivity is the key to survival. In some ways this is beautiful but in other ways it has contributed to a breakdown in nurturing quality time within families and within the larger community. The ultimate impact is steadily increasing isolation from each other and increasing rates of depression. Part of the work of the coalition and The Sophie Fund is to help us regain that sense of community through collective care and attention for each other’s well-being. To create comprehensive systems of mental health support for if and when any one of us feels buried under the weight of our lives is to build a resilient and vibrant community.”

Photo caption: Lee Ellen Marvin, executive director, Suicide Prevention and Crisis Service; Scott MacLeod, donor advisor, The Sophie Fund; Anna Kelles, Tompkins County legislator (District 2, City of Ithaca)

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Tompkins County Legislature Proclamation

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The Watershed Declaration

Meet the Tompkins County Suicide Prevention Coalition

More than 40 local mental health leaders launched the Tompkins County Suicide Prevention Coalition at a day-long working meeting held in Ithaca Monday.

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“It’s inspiring to see the breath of the organizations and individuals represented,” said Frank Kruppa, director of the Tompkins County Health Department. “It’s one of the things that makes Tompkins County special: when we have these types of issues, we are able to get folks in the room and talk about how we are going to tackle them.”

Deputy Commissioner of Mental Health Services Sharon MacDougall, the coalition’s organizer, said that the county seeks to foster greater collaboration in suicide prevention among the array of agencies and groups who deal with the issue.

“A coalition brings together all the experts that are in your county already,” she explained. “You have so many different perspectives, so many resources, so many different knowledge bases, and pulling them together gives you that focused lens on a community problem. We can help make that bigger effort to reducing suicide. If it is one death, it is one too many for Tompkins County. Zero suicide sounds like a lofty goal, but I think it has to be the goal.”

Garra Lloyd-Lester, associate director of the Suicide Prevention Center New York, briefed the participants on steps toward creating a successful suicide prevention coalition and presided over a Strengths-Weaknesses-Opportunities-Threats (SWOT) analysis.

“Things are off to a great start,” said Lloyd-Lester, who described the participants as “a diverse group of stakeholders, a cross section of people who are really invested in suicide prevention for the community.” But he warned that the coalition faced the critical challenge of sustaining momentum.

“At the meeting today, there was a lot of real energy, a lot of people all saying, ‘This is important work, we need to do it,’” Lloyd-Lester said. “How do you sustain that over the long haul? It’s a marathon, not a sprint. A coalition has to be built on more than just those individual champions. It’s got to be a culture, a way of doing things in the community. It takes recognition that no one entity can be responsible for suicide prevention in the community.”

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Garra Lloyd-Lester, Suicide Prevention Center New York

Lee-Ellen Marvin, executive director of the Suicide Prevention and Crisis Service in Ithaca, told the gathering that while Tompkins County’s suicide rate last year was seven deaths per 100,000, the actual number of suicide deaths jumped from four in 2014 and five in 2015 to 11 in 2016. “We can’t be complacent about suicide loss,” she said.

Marvin, whose agency has spearheaded suicide prevention in the area since 1969 by staffing a crisis hotline, after-trauma services, and education programs, listed two goals she hoped the coalition would help advance. The first is better understanding of people at risk in certain communities and how to reach them—such as financially struggling young adults, middle-aged men, gun owners, drug users. The second is adoption of the Zero Suicide Initiative, a commitment to suicide prevention in health and behavioral health care systems.

“What we need to communicate is that there is hope, there is help, and that there is absolutely no shame in getting help,” she concluded.

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Sharon MacDougall, Garra Lloyd-Lester, Lee-Ellen Marvin

Agencies and organizations represented at Monday’s meeting of the Tompkins County Suicide Prevention Coalition included:

Suicide Prevention and Crisis Service in Ithaca

Mental Health Association in Tompkins County

Family & Children’s Service of Ithaca

National Alliance on Mental Illness (NAMI) Finger Lakes

Care Compass Network

The Sophie Fund

Human Services Coalition

Alcohol & Drug Council of Tompkins County

Cayuga Addiction Recovery Services

Tompkins Community Action

Planned Parenthood Southern Finger Lakes

Franziska Racker Centers

Cayuga Medical Center

The Advocacy Center

Ithaca Free Clinic

Lakeview Mental Health Services

Cornell Health

Ithaca College Office of Counseling and Wellness

Ithaca College Office of Public Safety and Emergency Management

Empire State College

Ithaca City School District

Groton Central School District

Tompkins County Legislature

Tompkins County Health Department

Tompkins County Mental Health Department

Tompkins County Office for the Aging

Tompkins County Youth Services Department

Tompkins County Department of Emergency Response

Suicide Prevention Center New York

Broome County Suicide Awareness for Families and Educators

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Mayor Svante Myrick: Support Suicide Prevention

Ithaca Mayor Svante Myrick issued a proclamation Wednesday in support of The Watershed Declaration, a commitment by local mental health stakeholders to intensify efforts to prevent suicide in the community.

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“I call upon our citizens, government agencies, non-governmental organizations, health care providers, and educational institutions to raise awareness of Ithaca’s mental health support services, encourage those in need to seek treatment, honor those in our community we have lost too soon, and commit to an all-out effort to prevent suicide,” Svante said in issuing the proclamation at the start of the Ithaca Common Council meeting Wednesday evening.

The Watershed Declaration was adopted by acclamation at the close of a meeting held on April 17 of leaders from Tompkins County, the City of Ithaca, non-profit organizations, and the campuses of Cornell University, Ithaca College, and Tompkins Cortland Community College. The declaration termed suicide a “serious public health concern” and pledged to intensify suicide prevention efforts in Ithaca and Tompkins County.

Myrick said there is strong evidence that a comprehensive public health approach is effective in preventing suicide, and called on the community’s health and behavioral health systems to prevent suicide deaths using the best available information and practices.

Moreover, Myrick said, “every member of our community can play a role in protecting their friends, family members, and colleagues from suicide. Our community needs to advance suicide prevention by fighting the stigma around mental health and seeking treatment for mental disorders.”

Lee-Ellen Marvin, executive director of the Suicide Prevention and Crisis Service in Ithaca, expressed her gratitude for “the mayor’s support for reinvigorating our community’s commitment to suicide prevention. The need has never been greater. Unfortunately, suicide rates have been increasing in the last 15 to 20 years.”

“This proclamation is highlighting the need to address suicide prevention,” said Sharon MacDougall, deputy commissioner of Mental Health Services in Tompkins County. MacDougall added that her agency is working with the New York State Office of Mental Health to create a Tompkins County Suicide Prevention Coalition. “Selected key stakeholders will be invited to a planning meeting to start the Tompkins Suicide Prevention Coalition this summer,” she said. “This coalition will help coordinate the efforts of multiple agencies, providers and others to improve suicide prevention across Tompkins.”

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The Watershed Declaration was adopted by acclamation at a meeting of 18 organizations hosted by The Sophie Fund, which was established in memory of Cornell University art student Sophie Hack MacLeod to promote improved mental health for young people in the greater Ithaca area.

The Watershed Declaration stated:

“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.”

Photo caption: Ithaca Mayor Svante Myrick, The Sophie Fund Co-Donor Advisor Scott MacLeod, and Suicide Prevention & Crisis Service Executive Director Lee-Ellen Marvin

The Watershed Declaration

Community mental health stakeholders representing 18 organizations on Monday declared suicide a “serious public health concern” and pledged to intensify suicide prevention efforts in Ithaca and Tompkins County.

GarraLloyd-Lester                       Garra Lloyd-Lester, associate director of the Suicide Prevention Center New York

The call to action, known as The Watershed Declaration, was adopted by acclamation at the close of a meeting of leaders from Tompkins County, the City of Ithaca, non-profit organizations, and the campuses of Cornell University, Ithaca College, and Tompkins Cortland Community College.

The Watershed Declaration stated as follows:

“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.”

Lee-Ellen Marvin, executive director of the Suicide Prevention and Crisis Service in Ithaca, praised the call to action. “I was excited and moved to see leaders from different parts of our social service community together in one room, thinking about and committing to suicide prevention,” she said. “There is indeed a public health crisis, and the way to prevent suicide is with awareness, vigilance, and the willingness of all parts of society to commit to this effort.”

Addressing the gathering at The Watershed in Ithaca, Garra Lloyd-Lester, associate director of the Suicide Prevention Center New York, announced plans to convene a “key stakeholders” meeting in June with the aim of establishing a suicide prevention coalition in Tompkins County.

Lloyd-Lester explained that suicide is increasingly seen as a public health problem rather than just an issue to be handled by an individual and their therapist.

“Operationally, that means we can all play a role in helping individuals who might be struggling with thoughts of suicide, to help keep them safe,” said Lloyd-Lester. “Seeing the folks here today it is really reflective of this idea that suicide is everybody’s business. That is the mantra that the state talks about: suicide prevention is everybody’s business.”

Sharon MacDougall, Deputy Commissioner of Mental Health Services in Tompkins County, welcomed the state’s initiative. “Suicide prevention efforts in Tompkins County are strong and need collaboration among all our agencies, providers, and groups like The Sophie Fund,” she said. “A Suicide Prevention Coalition will help bring these efforts together in close collaboration—providing a unified and passionate Tompkins County voice advocating zero suicides in our county.”

Monday’s meeting was organized by The Sophie Fund, which advocates for improved mental health for young people in the greater Ithaca area.