Suicide Prevention: A New “Call to Action”

U.S. Surgeon General Jerome Adams on January 19 issued a “Call to Action” report to implement the 2012 National Strategy for Suicide Prevention, a detailed roadmap for preventing suicide in a comprehensive and coordinated way. “Much remains to be done,” the report warned. “Suicide prevention continues to lack the breadth and depth of the coordinated response needed to truly make a difference in reducing suicide.”

The report noted a new urgency behind suicide prevention efforts: the COVID-19 pandemic has now created conditions that may further suicide risk, such as increased social isolation, economic stress, and reduced access to community and religious support. “Problems resulting from the pandemic—including physical illness, loss of loved ones, anxiety, depression, job loss, eviction, and increased poverty—could all contribute to suicide risk,” Adams said.

The report said that in 2019 more than 47,000 Americans died by suicide, and that the national suicide rate increased 32 percent—from 10.5 to 13.9 per 100,000 people—in the 20-year period from 1999 to 2019. The report notes that for every person who dies by suicide, thousands more experience suicidal thoughts or attempt suicide—in a 2019 survey, 1.4 million U.S. adults reported attempting suicide in the past year and 3.5 million adults reported making a suicide plan.

“Although research has identified many strategies that can be effective in preventing suicide, these evidence-informed approaches have not yet been brought to scale,” the report said. Indeed, it added, an assessment of progress toward implementation of the National Strategy showed that few efforts have been comprehensive or strong enough to have a measurable impact on reducing suicidal behavior.

[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.]

The report highlights the Zero Suicide Model as one of the key instruments for saving lives. In 2018, the Tompkins County Suicide Prevention Coalition and the Tompkins County Legislature endorsed the model, which incorporates recommendations for “a gold standard of care for people with suicide risk.” The model stresses the need to include suicide prevention as a core component of all health care services, rather than limit it to services provided by mental health specialists, and to improve professional and clinical training and practice for preventing suicides.

The report calls for increased use of a key component of the Zero Suicide Model: a suicide safe care pathway, to ensure that patients at risk for suicide are identified and provided with continuing care tailored to their needs.

“All patients are screened on past and present suicidal behavior, and positive screens are followed by a full assessment. Individuals identified as being at increased risk are entered into a suicide safe care pathway, thus ensuring that they are provided with the attention and support they need to stay safe and recover.

“Components include periodic assessments of suicidality and ongoing follow-up, including contacting patients who fail to show up for an appointment or withdraw from care. The inclusion of family members and other identified support persons in pathway implementation may help support patient engagement.

“Implementation of a suicide safe care pathway requires that protocols and systems be in place to collect and analyze data to track services, ensure patient safety, and assess treatment outcomes. The system should collect data on process measures, such as screening rates, safety planning, and services provided; care outcomes; suicide attempts and deaths; and any other relevant factors, such as sociodemographic characteristics, clinical history, and referrals to other sources of care.

The report noted that in response to the need for a minimum standard of care for individuals at risk for suicide, the National Action Alliance for Suicide Prevention in 2018 developed Recommended Standard Care for People with Suicide Risk: Making Health Care Suicide Safe. It identifies individual recommended practices—such as screening and assessment for suicide risk, collaborative safety planning, treatment of suicidality, and the use of caring contacts—that can be adopted in outpatient mental health and substance misuse settings, emergency departments, and primary care.

Read: What Tompkins County is doing to prevent suicide deaths

The surgeon general’s Call to Action states that while that all 13 goals and 60 objectives of the 2012 National Strategy remain relevant, it is time to focus on six key actions in order to reverse the current upward trend in suicide deaths in the United States.

The Call to Action identifies four strategic directions: Healthy and Empowered Individuals, Families, and Communities; Clinical and Community Preventive Services; Treatment and Support Services; and Surveillance, Research, and Evaluation.

Within those directions, the Call to Action identifies six main actions to pursue:

Activate a broad-based public health response to suicide

Address upstream factors that impact suicide

Ensure lethal means safety

Support adoption of evidence-based care for suicide risk

Enhance crisis care and care transitions

Improve the quality, timeliness, and use of suicide-related data

Download: The Surgeon General’s Call to Action

SUMMARY OF THE CALL TO ACTION REPORT

Action 1. Activate a Broad-Based Public Health Response to Suicide: Inspire and empower everyone to play a role in suicide prevention.

1.1 Broaden perceptions of suicide, who is affected, and the many factors that can affect suicide risk.

1.2 Empower every individual and organization to play a role in suicide prevention.

1.3 Engage people with lived experience in all aspects of suicide prevention.

1.4 Use effective communications to engage diverse sectors in suicide prevention.

Action 1: Priorities for Action

  • State government and public health entities should implement the Suicide Prevention Resource Center’s Recommendations for State Suicide Prevention Infrastructure to support comprehensive (i.e., multi- component) suicide prevention in communities.
  • Prevention leaders from the public and private sectors, at all levels (national, state, tribal, and local), should align and evaluate their efforts consistent with the Centers for Disease Control and Prevention (CDC) resource Preventing Suicide: A Technical Package of Policy, Programs, and Practices, to expand the adoption of suicide prevention strategies that are based on the best available evidence.
  • Federal agencies and state, tribal, local, and county governments and coalitions should strengthen their prevention efforts by developing strategic suicide prevention plans based on available public health data. Mechanisms for the prompt sharing of innovations and best practices should be developed and supported.
  • State and local suicide prevention coalitions and health systems should actively reach out to organizations serving populations at high risk for suicide; these systems should also reach out to individuals with lived experience in order to learn from them and engage them in designing prevention efforts.
  • The public and private sectors should invest in patient-centered research and include people with lived experience in research design and implementation.
  • Federal agencies, mental health and suicide prevention non-governmental organizations, and others conducting communication efforts should ensure that suicide prevention communications campaigns (1) are strategic, (2) include clear aims for behavior changes that support broader suicide prevention efforts, and (3) measure their impact.
  • The federal government (Congress) should expand and sustain support for states, territories, communities, and tribes to implement comprehensive suicide prevention initiatives similar to the Comprehensive Suicide Prevention Program, funded by CDC, and the Garrett Lee Smith youth suicide prevention grants, funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), which have been shown to reduce suicide in participating counties, particularly in rural areas. Funding targeting substance use disorder should be broad enough in scope to allow for interventions that address suicide prevention and related workforce and infrastructure needs.

Action 2. Address Upstream Factors that Impact Suicide: Focus on ways to prevent everyone from suicide.

2.1 Promote and enhance social connectedness and opportunities to contribute.

2.2 Strengthen economic supports.

2.3 Engage and support high-risk and underserved groups.

2.4 Dedicate resources to the development, implementation, and evaluation of interventions aimed at preventing suicidal behaviors.

Action 2: Priorities for Action

  • Private companies and workplaces should leverage their health care benefits purchasing power to enhance employee mental health (e.g., invest in benefits and programs to prevent and treat behavioral health problems) and work to shape worksite values and culture to promote mental health by providing access to crisis support, support to employees following a suicide, and ongoing mental health wellness programming.
  • Suicide prevention leads in federal, state, tribal, and local public health and behavioral health agencies should partner with their counterparts in labor and workforce, housing, health care, and other public assistance agencies to collaborate on strengthening economic supports for families and communities.
  • Foundations and other philanthropic organizations that support early intervention programs— particularly those targeting (1) social determinants of health (e.g., reducing poverty and exposure to trauma, improving access to good education and health care, improving health equity) and/or (2) enhanced social interactions (e.g., improved parenting skills) and problem-solving and coping skills— should ensure that these programs include outcomes related to suicide (e.g., ideation, plans, attempts) and evaluation of those programs for suicide-related outcomes.
  • Federal government and private sector research funders should support the analysis of existing data sets of longitudinal studies to determine the impact of various interventions (e.g., home visitation, preschool programs, substance misuse, child trauma) on suicidal ideation, plans, and attempts, and on deaths by suicide. This could include such projects as the CDC’s efforts to assess and prevent adverse childhood experiences and examine their effect on suicide-related problems, and National Institutes of Health (NIH) initiatives that focus on aggregating prevention trial data sets to better understand the long-term and cross-over effects of prevention interventions on mental health outcomes, including suicide risk,88 and to address suicide research gaps.

Action 3. Ensure Lethal Means Safety: Keep people safe while they are in crisis.

3.1 Empower communities to implement proven approaches.

3.2 Increase the use of lethal means safety counseling

3.3 Dedicate resources to the development, implementation, and evaluation of interventions aimed at addressing the role of lethal means safety in suicide and suicide prevention.

Action 3: Priorities for Action

  • The federal government and private sector entities can support efforts to ensure that updated information on lethal means safety policies, programs, and practices (e.g., ERPOs, firearm owner and retailer education, bridge barriers, medication packaging, carbon monoxide shut-off sensors in vehicles) is incorporated into existing national clearinghouses and resource centers so that local municipalities, states, and tribes can adopt and evaluate them for their prevention benefits.
  • States, communities, and tribes should collaborate with the private sector to increase awareness of and take action to reduce access to firearms and other lethal means of suicide, including opioids and other medications, alcohol and other substances or poisons, and community locations (e.g., railways, bridges, parking garages) where suicidal behaviors have occurred. This urgent multi-sector effort is key to saving lives by reducing access to lethal means for individuals in crisis.
  • Health systems and payers should leverage their existing training and resources and collaborate on a national initiative to train general and specialty health care providers and care teams on safety planning and lethal means counseling.
  • SAMHSA and the VA should coordinate to ensure that lethal means safety assessment and counseling are incorporated into the assessment and intervention procedures of the National Suicide Prevention Lifeline and Veterans Crisis Line call centers, particularly in preparation for the national launch of 988.
  • The federal government can prioritize and fund research and program evaluation analyzing community and clinical lethal means safety interventions (e.g., ERPOs, firearm owner and retailer education, bridge barriers, medication packaging, carbon monoxide shut-off sensors in vehicles) at the population level.
  • State and federal governments should collaborate with the private sector on a synchronized public health communication campaign addressing lethal means safety in the context of suicide prevention, which should then be evaluated to determine prevention benefits and inform future communication efforts.

Action 4. Support Adoption of Evidence-Based Care for Suicide Risk: Ensure safe and effective care for all.

4.1 Increase clinical training in evidence-based care for suicide risk.

4.2 Improve suicide risk identification in health care settings.

4.3 Conduct safety planning with all patients who screen positive for suicide risk.

4.4 Increase the use of suicide safe care pathways in health care systems for individuals at risk.

4.5 Increase the use of caring contacts in diverse settings.

Action 4: Priorities for Action

  • The federal government, professional associations, and accrediting bodies should collaborate to address barriers to adopting the Action Alliance’s Suicide Prevention and the Clinical Workforce: Guidelines for Training to ensure increased clinical training in evidence-based care for suicide risk during graduate education and post-graduate training.
  • State behavioral health licensing boards should add continuing education requirements for suicide prevention in order for clinicians to maintain licensure or certification.
  • Payers from the public and private sectors should incentivize the delivery of evidence-based care via existing levers in contracting and reimbursement.
  • Federal and state policymakers and commercial payers and health systems should take specific steps to improve outcomes for individuals with mental health and substance misuse conditions in primary care by using effective methods (e.g., CoCM) to integrate mental health and substance misuse treatment into primary care.
  • To enhance workflows for suicide safe care, health systems should collaborate with EHR vendors to develop options for integrating screening, suicide safe care pathways, and safety planning into their EHR systems.

Action 5. Enhance Crisis Care and Care Transitions: Ensure that crisis services are available to anyone, anywhere, at any time.

5.1 Increase the development and use of statewide or regional crisis service hubs.

5.2 Increase the use of mobile crisis teams.

5.3 Increase the use of crisis receiving and stabilization facilities.

5.4 Ensure safe care transitions for patients at risk.

5.5 Ensure adequate crisis infrastructure to support implementation of the national 988 number.

Action 5: Priorities for Action

  • The federal government and the private sector should address gaps, opportunities, and resource needs to achieve standardization among crisis centers in interventional approaches and quality assurance in preparation for the launch of 988.
  • The federal government, states, and the private sector should work together to optimize system design, system operations, and system financing for 988 as the hub of an enhanced, coordinated crisis system, and enhance coordination between Lifeline 988 centers and 911 centers to reduce overreliance on 911 services and ED boarding (the practice of keeping admitted patients on stretchers in hallways due to crowding).
  • The federal government should fund the necessary infrastructure to support crisis care (e.g., Congressional support for the 5 percent SAMHSA Mental Health Block Grant set-aside; core services identified in SAMHSA’s National Guidelines for Behavioral Health Crisis Care) and should provide technical assistance to states looking to evolve crisis systems of care.
  • The federal government and foundations should support research to identify effective models of mental health crisis response (e.g., coordinated efforts among mental health specialists, peers, and law enforcement) to improve short- and long-term effects on communities of color and other marginalized populations.
  • The federal government and private sector payers should support the use of follow-up phone calls or texts within 24 hours of discharge from psychiatric hospitalization or emergency room discharge to check in with the patient, provide support, and maintain contact until the person’s first outpatient appointment.
  • The federal government should establish universally recognized coding for behavioral health crisis services, and public and private sector partners should collaborate with payers and health systems to increase adoption of the new coding.
  • The federal government should support the development of an essential benefits designation that will encourage health care insurers to provide reimbursement for crisis services, thus reducing the financial burden on state and local governments to pay for those services, delivered within a structure that supports the justice system and ED diversion.

Action 6. Improve the Quality, Timeliness, and Use of Suicide-Related Data: Know who is impacted and how to best respond.

6.1 Increase access to near real-time data related to suicide.

6.2 Improve the quality of data on causes of death.

6.3 Expand the accessibility and use of existing federal data systems that include data on suicide attempts and ideation.

6.4 Improve coordination and sharing of suicide-related data across the federal, state, and local levels.

6.5 Use multiple data sources to identify groups at risk and to inform action.

Action 6: Priorities for Action

  • The federal government should support near real-time collection of data on deaths by suicide and nonfatal suicide attempts in a group of sentinel states to develop the framework for a national early warning system for suicidal behavior in the U.S. The system would create a central database that links multiple data sources and would build state and local capacity to translate data trends into prevention efforts in a timely manner. In addition, the federal government should expand ED SNSRO to monitor nonfatal suicide-related outcomes, track spikes and potential clusters in suicide attempts, and identify patterns, all of which can then inform prevention activities.
  • The public and private sectors should collaborate on a near real-time suicide dashboard that pulls data from existing national, state, tribal, and community databases to make data on deaths by suicide and suicide attempts timelier and more accessible, thus linking the dashboard to prevention actions on the ground.
  • The federal government should implement Recommendation 1.8 of the Interagency Serious Mental Illness Coordinating Committee, which calls on public and private health care systems to routinely link mortality data for serious mental illness (SMI) and serious emotional disturbance (SED) populations, and supports the standardization of similar data gathering across state and local systems for SMI and SED populations within the justice system.
  • Professional organizations connected to coroners and medical examiners at the state and national levels should release guidance on and support wide-scale implementation of coding sexual orientation and gender identity in death investigations.
  • The federal government should implement the PREVENTS Executive Order recommendation for the U.S. Department of Health and Human Services and the VA to propose legislative changes that mandate a standardized process for uniform ED data reporting across the United States specific to the external cause of injury (e.g., suicide attempt).
  • Health care systems should work with public sector agencies to support the linkage of mortality data with health record, social, geographic, education, and criminal justice data systems to strengthen data quality and increase accountability for patient outcomes across key systems.
  • State suicide prevention coordinators and community suicide prevention leaders should routinely monitor available data to identify trends and evaluate their own efforts.

Suicide Prevention Day—What You Can Do

September 10 is World Suicide Prevention Day. It falls within Suicide Prevention Awareness Week. September is Suicide Prevention Awareness Month. The American Foundation for Suicide Prevention provides many helpful resources—to help yourself, support others, promote best practices, and advance better public health policies. Check out AFSP’s #KeepGoing page to see what you personally can do to prevent suicide.

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.

The Sophie Fund is dedicated to preventing suicide in the greater Ithaca community. Our nonprofit organization is named for Sophie Hack MacLeod, a Cornell University student who died by suicide in Ithaca in March 2016. Working with partners, we work to promote mental health awareness and advocate for specific best practices such as the Zero Suicide Model in the Ithaca community as well as on the local college campuses.

In 2017, The Sophie Fund led the adoption of the Watershed Declaration in which 18 community mental health stakeholders pledged to intensify efforts toward saving lives and bringing hope to those struggling with suicide thoughts or affected by suicide loss. The Sophie Fund is a founding member of the Tompkins County Suicide Prevention Coalition. In 2018, the Tompkins County Legislature called on local healthcare and behavioral healthcare providers to follow the Zero Suicide Model’s systematic clinical approach to preventing suicide.

Please contact us at thesophiefund2016@gmail.com for questions about our mission or to partner in our efforts.

State-Local Partnership in Suicide Prevention

The Sophie Fund on Thursday applauded New York Governor Andrew M. Cuomo’s 2019 “Justice Agenda” for including a proposal to strengthen suicide prevention infrastructure through state and local partnerships.

stateofstatecuomo

“While there is much still to be done, we truly thank Governor Cuomo for his commitment to preventing suicide in our state and for taking concrete actions in order to do so,” said Scott MacLeod, a co-founder of The Sophie Fund. “The governor understands the importance of addressing this challenge at the community level and with results-oriented strategies.”

In his annual State of the State Book accompanying an address to the legislature on Tuesday, Cuomo called on New York State agencies to partner with communities in five critical areas of suicide prevention: innovative public health approaches; healthcare systems; cultural competence in prevention programming; comprehensive crisis care; and surveillance data. Under the proposal, communities that demonstrably strengthen suicide prevention infrastructure will receive a New York State designation.

MacLeod noted that recent progress in Tompkins County’s suicide prevention efforts stemmed in part from the vital support provided by the state Suicide Prevention Office and affiliated Suicide Prevention Center of New York. In July 2018, the Tompkins County Legislature unanimously passed a resolution to support the Zero Suicide Model, a pillar of the state’s comprehensive suicide prevention policy. The resolution called on local healthcare and behavioral healthcare providers to follow the model’s systematic clinical approach to preventing suicides.

The legislative act 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.

“The state Suicide Prevention Office and Suicide Prevention Center of New York have been essential partners in the formation of the Tompkins County Suicide Prevention Coalition and in assisting local stakeholders with significantly expanding suicide prevention efforts,” said MacLeod. “We welcome the opportunity under Governor Cuomo’s proposal to expand our partnership with the state.”

Cuomo’s proposal builds on the work of the New York State Suicide Prevention Task Force formed at his direction in 2017. Cuomo charged the task force with identifying gaps in programs, services, and policies while simultaneously making recommendations to facilitate greater access, awareness, collaboration, and support of effective suicide prevention activities.

According to “Justice Agenda,” the 2019 State of the State Book:

“Suicide is an enormous public health problem. Suicide is the 10th leading cause of death in the United States. According to the Centers for Disease Control, from 1999 to 2016, suicide rates in New York State rose by nearly 30 percent, while other leading causes of death such as cancer, heart disease, and motor vehicle accidents all decreased. Each year nearly 1,700 New Yorkers die by suicide.”

In 2016, the state Suicide Prevention Office released “1,700 Too Many: New York State’s Suicide Prevention Plan 2016–17.” It focused on three main areas for battling the rising suicide rate: prevention in Health and Behavioral Healthcare Settings (Zero Suicide Model); Prevention in Competent, Caring Communities Across the Lifespan; and Suicide Surveillance and Data-Informed Suicide Prevention.

Time for a Mental Health Task Force at Cornell

We have written a letter to President Martha E. Pollack stating that the recent review of Cornell University’s mental health practices by The Jed Foundation is “plainly insufficient” and calling on her to appoint an external-led task force to perform an “independent, transparent, and robust review.”

IMG_9300 copy

Statue of Andrew Dickson White, Cornell’s first president, in the Arts Quad

Our daughter, Sophie Hack MacLeod ’14, died by suicide at age 23 in Ithaca while on a Health Leave of Absence from Cornell, where she was enrolled in the College of Architecture, Art, and Planning. In setting up The Sophie Fund in her memory to advocate for mental health initiatives aiding young people in the greater Ithaca community, we became very concerned about the mental health policies, programs, and practices for supporting Cornell students.

We initially wrote to President Pollack on April 19, 2017, just after she assumed office as Cornell’s 14th president, detailing our concerns about “systemic failure” in Cornell’s institutional handling of mental health matters, and called on her to establish an independent task force to report on Cornell’s mental health policies, practices, and programs and to make recommendations on needed improvements.

In a January 11, 2018 email to us, President Pollack declined our request. She cited an “external assessment” conducted by The JED Foundation, JED’s on-site visit to the Cornell campus in the summer of 2017, and Cornell’s “ongoing engagement with the foundation to ensure we are providing holistic support.” She also cited the JED review in subsequent remarks to Cornell’s Graduate and Professional Student Assembly (GPSA) and the Cornell Daily Sun.

In a letter last month, dated August 23, we informed President Pollack that we have examined what Cornell has made public about JED’s “external assessment” and concluded that it is plainly insufficient. It is not the independent, transparent, and robust review that we sought and that we believe Cornell’s students deserve. And it does not adequately address many of the concerns we raised in our original 2017 letter—about practical issues such as campus and off-campus mental health services and the high incidence of sexual assault and hazing misconduct, as well as policy concerns such as a defensive mindset that appears to prioritize Cornell’s public image over the welfare of students struggling with mental disorders.

We pointed out that, despite her promise to release the JED report, to date Cornell has chosen to publish—on the Cornell Health website—only two documents related to the review.

A glaring and troubling omission in the two posted documents is any reference in findings or recommendations regarding the capacity of the Counseling and Psychological Services staff to meet the demands of students for services. Another omission is any reference to the capacity of community mental health providers to address the needs of Cornell students referred to those off-campus services by CAPS. The documents report no findings and make no recommendations in areas such as academic workloads and faculty and academic staff handling of students in distress.

We explained to President Pollack that it does not appear that the JED review included a comprehensive assessment of Cornell’s suicide prevention policies and practices. However, we commended Cornell Health Executive Director Kent Bullis for recently announcing provisional support for the Zero Suicide Model initiative within the framework of the Tompkins County Suicide Prevention Coalition.

As we wrote in our letter to President Pollack, we do not believe that the JED review can be considered an independent external assessment because institutions of higher education pay The JED Foundation a $22,000 fee to become what JED calls “partners” in the JED Campus program. Furthermore, the director of Cornell’s Counseling and Psychological Services has a longstanding professional relationship with JED and is a member of its Advisory Board. The JED External Contributor who conducted JED’s on-site visit to the Cornell campus is a professional colleague of the CAPS director.

Neither of the two posted documents contain any JED findings; rather, in the first document JED merely makes brief comments on Cornell’s self-reported survey responses, and in the second document JED makes recommendations without reference to any findings they are presumably based on.

We understand that the review entailed only one on-site campus visit by a JED External Contributor, and the visit lasted merely three hours. We also understand that the External Contributor’s visit did not include meetings with any of the community providers who receive many CAPS referrals.

According to the JED Campus program, its partnerships with participating colleges’ mental health programs include the following five elements, which Cornell has not released: a Strategic Plan “complete with detailed objectives and action steps for implementation”; a Fourth-Year Post-Assessment “evaluating systems change”; a Healthy Minds Study, which JED describes as “an in-depth assessment of students’ attitudes, behaviors and awareness of mental health issues”; a Feedback Report on the JED Campus and Healthy Minds Study findings; and a Summary Report containing data analysis for the JED Campus assessment and the Healthy Minds Study. JED declined to release its Cornell report to us, citing a confidentiality agreement with Cornell.

We believe that the JED review is clearly inadequate for a comprehensive assessment of the serious mental health challenges faced by a large university campus today, especially one located in a small upstate community. As we reminded President Pollack, the 2017 Cornell PULSE Survey of 5,001 undergraduates reported that 71.6 percent of respondents often or very often felt “overwhelmed,” and 42.9 percent said that they had been unable to function academically for at least a week on one or more occasions due to depression, stress, or anxiety. Nearly 10 percent of respondents reported being unable to function during a week-long period on five or more occasions. Nine percent of the respondents—about 450 students—reported “having seriously considered suicide at least once during the last year,” and about 85 students reported having actually attempted suicide at least once in the last year.

We have often heard the view that Cornell’s mental health policies are better than those of many universities, and that Cornell’s mental health statistics are no worse. We find such a complacent view to be surprising and disappointing, especially coming from a world-renowned research institution. In fact, these escalating mental health challenges require a relentless approach in response from everyone in a position to act. We truly hope that President Pollack—and Cornell—will lead the way.

—By Scott MacLeod and Susan Hack

Scott MacLeod and Susan Hack are the co-founders of The Sophie Fund, a nonprofit organization advocating mental health initiatives aiding young people in the greater Ithaca community. The organization is named in memory of their daughter Sophie Hack MacLeod, a Cornell fine arts student who took her own life in Ithaca in 2016.

UPDATE 9/7/18:

Lee Swain, director of JED Campus, sent the following comment to The Sophie Fund:

I do see one inaccuracy I’d like to correct related to this paragraph:

“According to the JED Campus program, its partnerships with participating colleges’ mental health programs include the following five elements, which Cornell has not released: a Strategic Plan “complete with detailed objectives and action steps for implementation”; a Fourth-Year Post-Assessment “evaluating systems change”; a Healthy Minds Study, which JED describes as “an in-depth assessment of students’ attitudes, behaviors and awareness of mental health issues”; a Feedback Report on the JED Campus and Healthy Minds Study findings; and a Summary Report containing data analysis for the JED Campus assessment and the Healthy Minds Study. JED declined to release its Cornell report to us, citing a confidentiality agreement with Cornell.”

The elements you describe are part of our current program. I believe Erica explained to you how the program has changed. When Cornell joined, the program was designed slightly differently than is currently described on our website. For instance, we did not have a partnership with or include the Healthy Minds Study at that time. So, Cornell did not participate in that data collection. Also, Cornell is not completely through the four year program yet, which is why they have not posted or shared the “fourth year post assessment” as it has not yet been completed. It should also be noted that because Cornell joined an earlier version of the program than what is described on the website, they also only paid $1,950, the cost of the program at that time, not the $22,000 that schools currently pay which includes the Healthy Minds Study, a day long visit (sometimes a bit more) and policy and protocol review (both at the beginning of the program and throughout as policies are changed/adapted). We also collect more data on counseling center utilization, crisis incidents, and staffing patterns in the current version of the program than in the original version.

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.

IMG_9285

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…

IMG_9269

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.

[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.]