Why We Support the Zero Suicide Model

The Tompkins County Legislature passed a resolution a year ago 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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Members of the Cayuga Health Partners Care Coordination Team

Cayuga Health Partners, a Physician-Hospital Organization comprising more than 40 medical practices and 200 physicians and a leader of healthcare delivery in Tompkins County, pledged to become a “Zero Suicide Champion” with the goal of implementing the suicide prevention model in our local healthcare network.

That pledge was made during a June 2018 meeting of the Tompkins County Suicide Prevention Coalition, formed in 2017 by more than 30 community-based organizations. Others announcing their commitment included Cayuga Medical Center, Tompkins County Mental Health Services, Alcohol & Drug Council of Tompkins County, Suicide Prevention & Crisis Service, Cornell Health of Cornell University, and Family & Children’s Service of Ithaca.

The Zero Suicide Model involves a foundational belief that suicide deaths for those engaged in the healthcare system are preventable. It is clear that safer suicide care is in the best interest of our patient population. I know for myself and my team, we all want to go to bed at night knowing we’ve done everything in our power to support the well being of the communities we serve.

The case for Zero Suicide is compelling. The New York State Office of Mental Health has released data showing that an overwhelming number of those who die by suicide are often already engaged in health systems. More than 80 percent of people who die by suicide have had health care visits in the prior 12 months—often more recently than that. These findings are consistent with national data.

Making the commitment to become a Zero Suicide Champion was the easy part. Now, utilizing the specific strategies and tools available free of charge to practices and providers nationwide through the Zero Suicide framework, Cayuga Health Partners is working to prevent suicides while improving the care for those who seek help.

Cayuga Health Partners is working in collaboration with Ithaca’s Suicide Prevention and Crisis Service in an effort to encourage individual practices and providers to embrace the Zero Suicide Model. In the fall of 2018, we launched a series of Lunch & Learn events featuring presentations about the model by SPCS Executive Director Lee-Ellen Marvin. To date, more than 60 percent of the primary care practices in the network have opened their doors to the presentations and discussions about the role they can play in suicide prevention. Members of Cayuga Health Partners have also played a role in supporting our partner organization, Cayuga Medical Center, in its own implementation of the Zero Suicide Model.

Cayuga Health Partners (formerly called Cayuga Area Plan/Preferred) is a partnership of the Cayuga Area Physicians Alliance (CAPA) and Cayuga Medical Center. Our network mission is to unify member organizations in the pursuit of high quality, accessible, and cost-effective healthcare for the population of patients we serve. In efforts to accomplish this, Cayuga Health Partners is a physician-led, physician-driven effort combining evidence-based best practices and innovative data collection technology in a way that aligns physician incentives and community partnerships to drive improvement in clinical quality.

For more information about the Zero Suicide Model, go to: http://zerosuicide.sprc.org/

—By Emily Mallar

Emily Mallar is the director of Care Management at Cayuga Health Partners

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.

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“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.

Albany Honors The Sophie Fund with Mental Health Advocacy Award

The New York State Office of Mental Health on Thursday presented The Sophie Fund with an Excellence in Suicide Prevention award for its mental health advocacy work in Tompkins County at the state’s 2018 Suicide Prevention Conference held in Albany.

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The Sophie Fund and its founders, Scott MacLeod and Susan Hack, received the state’s Journey of Healing Award for “exemplary advocacy by a Suicide Attempt or Suicide Loss Survivor.”

MacLeod and Hack established The Sophie Fund to support mental health initiatives aiding young people after the 2016 death by suicide of their 23-year-old daughter, Sophie Hack MacLeod, a Cornell University student.

“The Sophie Fund is a beautiful example of how a tragic loss can transform a community,” said New York State Office of Mental Health Commissioner Dr. Ann Marie T. Sullivan.

“Scott and Susan took their painful loss and channeled it into a passion to save lives in Tompkins County. We thank Scott, Susan and everyone involved in The Sophie Fund for their hard work and commitment to suicide prevention.”

Said Lee-Ellen Marvin, executive director of Ithaca’s Suicide Prevention & Crisis Service (SPCS): “Scott and Susan have transformed their grief in just two years into a powerful force of influence for suicide prevention in Tompkins County.”

SPCS, the Tompkins County Mental Health Department, and Tompkins County Legislator Shawna Black nominated The Sophie Fund for a 2018 Excellence in Suicide Prevention award. State officials cited The Sophie Fund’s “tenacity” in securing the adoption of The Watershed Declaration in 2017, which called for intensified suicide prevention efforts in the county, and in advocating for the Zero Suicide Model to be adopted by local healthcare providers.

The Sophie Fund also has sponsored student mental health programming at Cornell University and Ithaca College; mental health first aid training; a series of bookstore readings by authors of books on mental health; and artists who address mental health and suicide themes. It is working on an initiative to support college students taking a health leave of absence. The Sophie Fund also sponsors the annual Ithaca Cupcake Baking Contest to raise mental health awareness and raise monies for local mental health nonprofits.

MacLeod and Hack thanked the Office of Mental Health and the Tompkins County nominators for Thursday’s recognition.

“In the loss of our precious Sophie in 2016, we witnessed the profound depths of mental illness and the immense tragedy of suicide,” they said in a statement released by the Office of Mental Health. “In establishing The Sophie Fund in her memory, we resolved to do everything possible to support young people battling mental disorders. Suicide is preventable, and we also resolved to do everything we could so that we do not lose one more person, young or old, to suicide in Sophie’s adopted Ithaca–Tompkins County community.”

MacLeod and Hack also paid thanks to “the countless people who have made The Sophie Fund’s work a reality”—supporters and partners in Tompkins County, friends, family, and others in the greater Ithaca area and beyond, and the New York Suicide Prevention Office.

Sophie was born in Johannesburg and spent her childhood living in South Africa, then France, and eventually Egypt. But she adopted Ithaca as her hometown, spending five summers in the violin program of the Suzuki Institutes at Ithaca College and then enrolling at Cornell in 2010. At the time of her death, she was on a health leave of absence from Cornell and working in Ithaca’s vibrant culinary scene.

Photo caption: Sigrid Pechenik, associate director, New York State Suicide Prevention Office; Susan Hack, co-founder, The Sophie Fund; Jay Carruthers, director, New York State Suicide Prevention Office; and Garra Lloyd-Lester, director, New York State Suicide Prevention Community Initiatives

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.”