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.”

Dash! Splash! It’s Newfield’s Color Run!

The grounds of Newfield High School were ablaze in festive shades of pink, blue, and orange on Saturday as some 250 students, parents, and community members took part in the school’s annual spring Color Run.

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Under a brilliant sun and cloudless sky, everyone from senior citizens to toddlers in strollers to families with pets in tow trekked along their choice of routes—the standard five-kilometer course, one-mile course, or the “family” half-mile track. At five stations along the way the joggers and walkers were doused with colored powder, sometimes to shrieks of delight. With dozens of volunteer organizers on hand to help, music, lawn games, and hot dogs rounded out the day’s fun.

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The Color Run is sponsored by—and raises money for—a great student club at Newfield High School, Sources of Strength (SOS). This is part of a national peer-led suicide prevention program, originally developed in North Dakota in 1998, that promotes hope, help, strength, and connections, and provides support to struggling students.

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Newfield High School heard about Sources of Strength six years ago, and affiliated researchers and trainers at the University of Rochester offered two years of support and a bit of funding to help pilot the program in some Tompkins County schools.

What made this program so appealing to us at Newfield was the unique focus of having peer leaders deliver powerfully positive, strength-driven messages. The University of Rochester researchers had already collected solid data from several schools in North America proving the effectiveness of Sources of Strength.

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As Sources of Strength explains it:

“A best practice youth suicide prevention project designed to harness the power of peer social networks to change unhealthy norms and culture, ultimately preventing suicide, bullying, and substance abuse. The mission of Sources of Strength is to prevent suicide by increasing help seeking behaviors and promoting connections between peers and caring adults. Sources of Strength moves beyond a singular focus on risk factors by utilizing an upstream approach for youth suicide prevention. This upstream model strengthens multiple sources of support (protective factors) around young individuals so that when times get hard they have strengths to rely on.”

Each fall, the club’s co-advisors—myself and high school counselor Rick Pawlewicz—take our group of diverse peer leaders through a half-day training to learn about the mission and key messages of Sources Of Strength.

In becoming key “connectors” in their school, the peer leaders focus on identifying and utilizing eight different strengths in our lives: positive friends, healthy activities, family support, mentors, spirituality, generosity, medical access, and mental health. They share stories at weekly SOS meetings about struggles, stressors, and how they use personal sources of strength to get through tough times. Helping to break the silence around mental health, peer leaders actively seek out others to connect them with resources and to their own sources of strength. They continually send the message that it’s okay to talk about tough times, and that it’s essential to tap into our personal strengths and reach out for help.

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SOS peer leaders at Newfield High have created, facilitated, and engaged in countless messaging activities inside our school and in the wider community. The activities include simple, visual messages like posters, cards, videos, and social media posts; trivia games during all lunch periods; Sources of Strength Weeks; pep rallies; and the annual Extravaganzas—nights of fun on campus with games, music, art, and food. The peer leaders give community presentations on their activities, to the Newfield Central School District Board of Education and the Tompkins-Seneca-Tioga Board of Cooperative Educational Services (BOCES). And, of course, hundreds of community members come out for the annual Color Run.

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We are proud of Newfield High School’s peer leaders and the mentors (teachers, staff, administrators, coaches, etc.) who support their efforts to promote hope, help, strength, and connections throughout every corner of our community. Our goal is that every student knows that they are not alone, and there is always help and support available.

—By Jamie McCaffrey

Jamie McCaffrey, LCSW is a social worker in the Newfield Central School District

Photos courtesy Jamie McCaffrey

 

Who Runs for Newfield High?

Fancy a splash of color in your life? We mean that literally! Come out and join the annual Color Run at 10 a.m. Saturday June 16 at Newfield High School. Participants in the five-kilometer trek (walkers and cheering supporters are welcome, too) are doused at eight intervals with colored, non-toxic cornstarch. All for a great cause: to support Newfield’s Sources of Strength, a school club dedicated to spreading hope, help, and strength in the community.

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Scene from Sources of Strength’s 2017 Color Run

Runners and walkers wearing white t-shirts pass through eight color stations, each one representing a “source of strength”: family support, positive friends, mentors, health activities, generosity, spirituality, medical access, and mental health.

Besides fostering community spirit, the event is a fundraiser for Sources of Strength, which promotes mental health and wellness for fellow students. The group meets regularly for rap sessions focused on promoting personal strengths and community-message brainstorming, and directs struggling students to helpful resources. It organizes de-stressor events like SOS Extravaganza, which turns the high school campus into a night-long party with movies, games, and snacks.

Click here for the sign-up form.

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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