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.”

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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.

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Tompkins County Legislature July 17, 2018

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

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

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

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

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

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

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

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

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

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

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

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

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

The Tompkins County resolution reads in part:

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

WHEREAS, suicides are preventable, now therefore be it

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

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

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

Specifically, this entails a systematic clinical approach in healthcare systems—training staff, screening for suicide ideation, utilizing evidence-based interventions, mandating continuous quality improvement, treating suicidality as a presenting problem—and not simply relying on the heroic efforts of crisis staff and individual clinicians.

As the Suicide Prevention Resource Center (SPRC) puts it:

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

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

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

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

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

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

Tompkins Coalition: “Yes” to Zero Suicide Model

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

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

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

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

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The Zero Suicide Model holds that suicide prevention is a core responsibility of healthcare. Specifically, this entails a systematic clinical approach in healthcare systems—training staff, screening for suicide ideation, utilizing evidence-based interventions, mandating continuous quality improvement, treating suicidality as a presenting problem. The model’s developers argue that suicides can be prevented by closing cracks in healthcare systems—that “suicide deaths for individuals under care within health and behavioral health systems are preventable.”

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

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

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

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

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

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

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

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

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

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

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

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

Can Tompkins County Prevent Suicides?

Kate Spade and Anthony Bourdain lived the American Dream—professional success, financial security, happy families. No wonder the nation was shocked to learn of their deaths by suicide last week. Were there warning signs? Spade’s husband revealed that the iconic fashion designer was receiving treatment for depression and anxiety. Bourdain’s mother said the celebrity chef and journalist was in a “dark mood” shortly before his death.

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To share current efforts to fight suicide in our community, the Tompkins County Suicide Prevention Coalition invites the general public to a presentation on the Zero Suicide Model. The presentation, by Olivia B. Retallack of the New York State Suicide Prevention Office, will take place from 2-3:30 p.m. Monday June 18 in the Borg Warner Room of the Tompkins County Public Library.

The Coalition has taken up the proposed adoption of the Zero Suicide Model as a priority. Zero Suicide is a set of strategies and tools for suicide prevention in health and behavioral health care systems. 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.”

Zero Suicide considers 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.

As the Suicide Prevention Resource Center 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 health care system, and on the premise that a systematic approach to quality improvement is necessary.”

Presentation on the Zero Suicide Model

Olivia B. Retallack

New York State Suicide Prevention Office

June 18, 2018   2–3:30 p.m.

Borg Warner Room

Tompkins County Public Library

To RSVP, click on the link: https://www.surveymonkey.com/r/ZeroSuicidePresentation

“Thank You for Your Work”

New York state officials singled out The Sophie Fund as well as the Suicide Prevention and Crisis Service this week for their leadership and commitment in promoting improved suicide prevention practices in Tompkins County.

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Tompkins County proclamation of suicide prevention month (September 2017): Lee-Ellen Marvin, executive director, Suicide Prevention and Crisis Service; Scott MacLeod, The Sophie Fund; Anna Kelles, Tompkins County legislator

In a March 26 letter addressed to the two Ithaca organizations, Jay Carruthers, director of the state Suicide Prevention Office, and Sigrid Pechenik, director of the state Suicide Prevention Center, also applauded the suicide prevention efforts of city and county officials and local mental health stakeholders.

“We thank you and applaud the efforts that have taken place in Tompkins County over the past year,” wrote Carruthers and Pechenik. “Under your leadership and commitment to make Tompkins County a suicide safer community, you introduced and pushed forward the state’s vision.”

The state officials said they particularly acknowledged “The Sophie Fund’s efforts to bring Zero Suicide into healthcare systems in Tompkins County.” They noted that The Sophie Fund organized a summit to introduce the Zero Suicide Model to county outpatient, inpatient, and college campus leadership; created a website page devoted to Zero Suicide resources; and asked the Tompkins County Suicide Prevention Coalition to form a committee to focus on Zero Suicide Model implementation.

Remarking on the “extraordinary progress” achieved over the past year, Carruthers and Pechenik added: “We consider Tompkins County and its newly formed Suicide Prevention Coalition an exemplary testament to vision, dedication and mobilization of community stakeholders.”

The letter highlighted The Watershed Declaration, a community pledge to intensify suicide prevention efforts; Ithaca Mayor Svante Myrick’s proclamation recognizing suicide as a public health concern; and the Tompkins County legislature’s designation of September as suicide prevention month.

“As the New York State Prevention Plan states, ‘suicide prevention cannot succeed without community involvement and leadership.’ Thank you for your work,” Carruthers and Pechenik concluded.

Read the Full letter

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Download “1,700 Too Many: New York State’s Suicide Prevention Plan 2016–17”