Five Years After The Watershed Declaration

Five Aprils ago, The Sophie Fund organized a meeting of community mental health stakeholders representing 18 governmental and non-profit organizations from Tompkins County, the City of Ithaca, and the campuses of Cornell University, Ithaca College, and Tompkins Cortland Community College.

Co-Founder Scott MacLeod introduced The Sophie Fund to the community, explaining that it was established in memory of his daughter who died by suicide in Ithaca the previous year, and outlining its mission to support mental health initiatives aiding young people in the greater Ithaca area.

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

At the close of the April 17, 2017 meeting, the assembled stakeholders adopted a solemn resolution. It was dubbed The Watershed Declaration, as the meeting was hosted by The Watershed, a new downtown watering hole owned by Sophie’s friend and former colleague.

The declaration reads:

“We the assembled mental health stakeholders of the greater Ithaca community and Tompkins County recognize suicide as a serious public health concern. Today we renew our commitment to suicide prevention and pledge to intensify efforts toward saving lives and bringing hope to those struggling with suicide thoughts or affected by suicide loss.”

How did that pledge turn out? The results are mixed.

Since The Watershed Declaration was adopted, Tompkins County has averaged 12 suicide deaths per year. There is anecdotal evidence of a spike in local suicides, including those on college campuses, in 2021 and 2022. Suicide is the second leading cause of death among Americans aged 10-34.

GET INVOLVED: Interested to join the cause of suicide prevention? Email The Sophie Fund at thesophiefund2016@gmail.com

In June 2017, then Ithaca Mayor Svante Myrick issued a proclamation in support of The Watershed Declaration, and the Tompkins County Legislature proclaimed September 2017 to be The Watershed Declaration Month.

Led by Tompkins County Mental Health Services, 40 local mental health leaders came together in July 2017 and launched the Tompkins County Suicide Prevention Coalition.

In October 2017, The Sophie Fund organized an expert briefing at the Statler Hotel for senior healthcare administrators throughout Tompkins County; the topic was the Zero Suicide Model, which is designed to improve suicide prevention measures in healthcare systems.

Eight months later, the Suicide Prevention Coalition adopted Zero Suicide as its policy; eight healthcare providers stepped up to declare themselves “Zero Suicide Champions,” pledging to explore implementation of the model. In July 2018, the county legislature unanimously passed a resolution to support Zero Suicide, calling on local healthcare and behavioral healthcare providers to follow the model’s systematic clinical approach to preventing suicides.

Coalition work toward drafting a strategic plan, creating a leadership team, expanding membership, conducting outreach, and following up on Zero Suicide implementation badly drifted in 2020; this was partly due to leadership transitions throughout the county’s healthcare agencies, as well as disruptions caused by the Covid-19 pandemic.

The coalition resumed monthly meetings in February 2021, elected Sally Manning of Racker as convener, and resumed work on a strategic plan.

In February 2022, then coalition unanimously adopted a three-year strategic plan guided by a vision “for a community where no lives are lost to suicide” and using data, science, and collaborations to implement effective strategies.

The five-point plan calls for using data to inform suicide prevention strategies; advancing the Zero Suicide Model in healthcare; reducing suicide in the youth population; reducing access to lethal means; and advocating for policies and practices to prevent suicide. The coalition has formed work groups to drive efforts in all five areas.

For its part, The Sophie Fund re-launched its Zero Suicide Initiative with a series of presentations and trainings to reinvigorate work on the model in Tompkins County.

On November 16 The Sophie Fund hosted “Call to Action: Suicide Prevention in Healthcare,” an expert briefing for top healthcare leaders by Jenna Heise, director of Suicide Prevention Implementation at the Suicide Prevention Center of New York.

This was followed on March 9 with “Understanding, Identifying, and Addressing Suicide Risk: A Clinical Primer for Behavioral Health Providers,” a training with national suicide prevention leaders hosted by The Wellness Institute.

The Sophie Fund on March 24 hosted “Implementation of Zero Suicide,” a suicide prevention presentation for front line managers representing 10 leading healthcare providers in Tompkins County; it was led by Tammy Weppelman, the State Suicide Prevention Coordinator at the Texas Health and Human Services Commission, and Mike Olson, the crisis program manager at My Health My Resources, an agency currently implementing the model in in Tarrant County, Texas.

On June 16, Virna Little, CEO of Concert Health and a leading expert on integrating primary care and behavioral health, will provide a briefing for primary care physicians and their teams on implementing Zero Suicide protocols in primary care practices.

Finally, in June Jenna Heise of the Suicide Prevention Center of New York will return to Ithaca for a roundtable discussion with top healthcare leaders on Zero Suicide implementation progress.

Advancing “Zero Suicide” in Tompkins County

The Sophie Fund on March 24 hosted “Implementation of Zero Suicide,” a suicide prevention presentation for front line managers representing 10 leading healthcare providers in Tompkins County.

Tammy Weppelman, the State Suicide Prevention Coordinator at the Texas Health and Human Services Commission, outlined the seven elements involved in implementing the Zero Suicide Model. Weppelman was joined in her presentation by Mike Olson, the crisis program manager at My Health My Resources, an agency currently implementing the model in in Tarrant County, Texas.

The Zero Suicide Model is designed to eliminate gaps in systems of care for treating patients experiencing suicidal behaviors; research has shown that more than 80 percent of people who died by suicide had seen a healthcare provider in the previous 12 months, almost 50 percent within a month of their death, and more than 20 percent within their final week of life.

“Suicide prevention is a core function of the organization, it’s everybody’s business,” Weppelman said. “Suicide is preventable. The culture in your organization is a just culture, which means that you look at suicide as a system failure rather than an individual failure. It’s not an issue with a specific clinician or something that one person did that led to someone dying by suicide. But, collectively, as a organization, or as a system, what can we do better to prevent suicide.”

LEARN MORE: The Zero Suicide Model in Tompkins County

Weppelman said that leadership, the first element of the model, entails a healthcare provider creating an implementation team. She said it was essential that the team include top leadership decision-makers as well as individuals within the organization who are personally passionate about preventing suicide.

“Leaders are easily drawn to other priorities,” she explained. “But the passion on your implementation team, they’re not going to be drawn to other priorities. They’re going to keep that team driving forward.”

Olson discussed evidence-based training as a second element of Zero Suicide, “making sure that especially your direct care staff, or your front line staff, is competent in suicide prevention, but also confident in their ability to identify suicide risk and respond to that risk appropriately.”

He said that training provides skills for universal screening for suicide risk, assessment of treatment needs, and safety planning. A tangible first step, he added, calls for healthcare organizations to administer a workforce survey about suicide prevention capabilities at least every two to three years.

Weppelman reviewed a third element, identifying suicide risk. In all healthcare settings, she explained, “we want to do universal screening, screening every person, every visit, every time.” A recommended tangible first step, she said, is choosing a screening tool, such as C-SSRS or ASQ.

“In my experience, people don’t come out and say they’re having thoughts of suicide without somebody asking them,” she explained. “If you do ask, most of the time they’re honest, because they know that it’s a safe place or a safe person to talk to. So the the benefit of universal screening is that if you ask, you’re going to catch people. And if you don’t ask, you’re not.”

“I’ve heard somebody say, ‘It seems like a lot. What if somebody comes in every week? You ask them every week about suicide?’ Yes, it’s kind of like every time you go to the doctor you get your blood pressure taken, you get your temperature taken. Asking about suicide is like a mental health vital sign.”

The next element of Zero Suicide is to engage people who screen for high risk in a care management plan, a clinical pathway, Olson said. He said that this involves developing an individual safety plan with the patient, such as one using the Brown-Stanley Safety Plan template, that provides quick tips for self-care in a crisis, emergency contact information, and a reminder to remove access to any lethal means. Care management will also entail ongoing risk assessment and procedures for follow up care, he said.

Weppelman said that another element is using evidence-based treatment interventions. She explained that Zero Suicide calls for interventions that are specific to reducing suicide risk, as opposed to treatments for illnesses such as depression that are thought to be related to suicide. She said that recognized suicide-specific interventions include Collaborative Assessment and Management of Suicidality (CAMS); Dialectical Behavioral Therapy (DBT); and Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP).

Olson said that a sixth element focuses on the healthcare organization’s capacity to manage suicide risk during transitions in care. He said this includes supporting individuals transitioning from the emergency department or psychiatric hospitals; those who miss appointments or withdraw from care; and individuals transitioning to a new service provider.

He said that the transition element has been the trickiest for his agency. “Services are optional, we can’t force patients to to engage in services if they don’t want to,” he said.

Yet, Olson said, Zero Suicide calls for reengaging patients through “caring contacts”—“very basic correspondence just saying, ‘Hey, we haven’t seen you at the clinic in a while, you know we’re here for you if you need us.’” He said it also calls for “warm handoffs” to onward providers, so the patient “doesn’t fall through the cracks during that transition period.” He said his agency utilizes the Care Coordination Agreements and Care Transitions model for “making sure there’s timely follow up after any type of discharge from the hospital.”

“Individuals are 273 percent more likely to die by suicide within 30 days of a care transition, so these times are so super important,” Weppelman added.

Weppelman recalled her experience working in crisis services at a Dallas-Fort Worth area community mental health center that implemented Zero Suicide. She said that the center established memorandums of understanding with local hospitals so that when they discharged a patient in need of psychiatric follow-up for outpatient services, “they would be direct dropped to our door—within an hour of discharge, we would be seeing them.” When somebody presented at the emergency department after a suicide attempt, the center would dispatch a mobile crisis team to follow up, she said.

The seventh Zero Suicide element is continuous quality improvement. Weppelman said that this entails the use of data, keeping track of suicide deaths and suicide attempts within a provider’s system. She said that another aspect of improvement is developing a Zero Suicide implementation plan, starting with small goals that can be more easily achieved. She suggested doing one thing to drive efforts forward in the next 30 days, and then setting three goals for the next 90 days, and three goals for the next year.

“It’s not an initiative that you start today, and you end next week,” she explained. “It’s always a continuous quality improvement project.”

The presentation for front line managers was the third in a series of presentations and trainings on Zero Suicide hosted by The Sophie Fund.

It was attended by representatives from leading healthcare providers, including: Tompkins County Mental Health Services; Cayuga Medical Center; Cayuga Health Partners; Suicide Prevention and Crisis Service; Family & Children’s Service of Ithaca; Guthrie Cortland Medical Center; Alcohol & Drug Council of Tompkins County; Cornell Health and its Counseling & Psychological Services; Center for Counseling and Psychiatric Services at Ithaca College; and Health and Wellness Services and Mental Health Counseling at Tompkins Cortland Community College. The presentation was also attended by Sally Manning, convener of the Tompkins County Suicide Prevention Coalition.

Previous events included “Call to Action: Suicide Prevention in Healthcare,” an expert briefing on the Zero Suicide Model for Tompkins County healthcare leaders on November 16 by Jenna Heise, Director of Suicide Prevention Implementation at the Suicide Prevention Center of New York; and “Understanding, Identifying, and Addressing Suicide Risk: A Clinical Primer for Behavioral Health Providers” on March 9 by The Wellness Institute.

On June 16, Virna Little, CEO of Concert Health and a leading expert on integrating primary care and behavioral health, will provide a briefing for primary care physicians and their teams on implementing Zero Suicide protocols in primary care practices.

The Tompkins County Suicide Prevention Coalition on February 24 unanimously adopted a three-year strategic plan guided by a vision “for a community where no lives are lost to suicide” and using data, science, and collaborations to implement effective strategies; implementation of the Zero Suicide Model is one of the plan’s main objectives.

Zero Suicide is the healthcare pillar of “1,700 Too Many: New York State’s Suicide Prevention Plan 2016–17,” as well as of the 2021 “Surgeon General’s Call to Action to Implement the National Strategy for Suicide Prevention.”

New Plan for Preventing Suicides in Tompkins County

The Tompkins County Suicide Prevention Coalition on February 24 unanimously adopted a three-year strategic plan guided by a vision “for a community where no lives are lost to suicide” and using data, science, and collaborations to implement effective strategies.

T-shirts for the Greater Ithaca “Out of the Darkness” Walk, September 18, 2021

The plan noted that suicide continues to be the second leading cause of death among Americans aged 10-34, and in Tompkins County approximately half of the population is under 30.

“We believe that the persistent rise in the U.S. suicide rate over the past two decades demands a public health response from communities across the nation,” the plan stated. It said that since 2016, Tompkins County has averaged 12 suicide deaths per year. Another 1,600 parents, children, siblings, friends, and spouses may have been negatively impacted by resulting psychological, spiritual, and/or financial loss, it added.

The plan seeks to improve the quality and enhance the use of data sources and systems for suicide prevention in Tompkins County. It proposes the development of a data collection infrastructure to regularly collect timely, high quality, and interpretable data on those at risk of suicide. It calls for a county dashboard that integrates data from multiple sources for the purposes of surveillance, monitoring program/policy impact, and informing the coalition’s planning and activities.

The plan’s second goal is to advance quality improvement for suicide care in all Tompkins County healthcare and behavioral health settings. It seeks to promote and facilitate the implementation of the Zero Suicide Model in the county’s major healthcare and behavioral health settings as well as in primary care practices and clinical therapy practices. The plan calls for the formation of a Zero Suicide Work Group comprised of health and mental health providers, and funding for a coordinator to manage and assist education, training, and other collaborative activities.

Another goal is to reduce suicide attempts in the youth population, including students attending local colleges, through suicide awareness activities and “gatekeeper” training programs.

The plan seeks to reduce access to lethal means for suicide within high-risk demographic populations as determined by national, state, and local data. It calls for suicide prevention awareness programming related to suicide death by firearms and suicide death by drug overdose.

Finally, the plan seeks to advocate for policies and practices designed to prevent suicides in the community and to request support and funding from government agencies and nonprofit organizations. The plan said the coalition would support legislation in the New York State Legislature for full funding for the enhancement of crisis response services aligned with the introduction of the 988 suicide prevention lifeline number in 2022.

The plan said that the coalition is committed to measuring the results of its strategic plan and making them public. The coalition drafted its strategic plan with the support of the Suicide Prevention Center of New York.

The Suicide Prevention Coalition was founded in 2017 by 40 health agencies, community organizations, and individual members who share a determination to prevent suicide deaths in Tompkins County. “The coalition draws inspiration and purpose from The Watershed Declaration, a call to action by Tompkins County mental health leaders to renew our community’s commitment to suicide prevention,” the plan said.

Training Tompkins Clinicians in Suicide Prevention

The Sophie Fund is sponsoring scholarships for licensed therapists and social workers in Tompkins County to attend an online training in suicide prevention, “Understanding, Identifying, and Addressing Suicide Risk: A clinical primer for behavioral health providers.”

The Wellness Institute’s training summit will feature national experts in suicide prevention

The training is sponsored by The Wellness Institute and the American Foundation for Suicide Prevention, and will feature presentations by national experts on suicide prevention in clinical practice. It will take place from 11 a.m. to 6 p.m. on Wednesday, March 9, 2022.

Licensed therapists and social workers working in Tompkins County can receive a registration link for a scholarship by emailing thesophiefund2016@gmail.com. Applicants must provide their name, degree level, and place of employment (or name and address of practice, if self-employed). CE credits are available.

The training is designed to build and strengthen clinicians’ competence and confidence to provide caring evidence-based services to clients with suicide risk and those who have experienced suicide loss.

This event is part of The Sophie Fund’s series of trainings and presentations to support the NY Office of Mental Health’s renewed focus on implementing the Zero Suicide Model across New York State.

On November 16, The Sophie Fund hosted an expert briefing on the Zero Suicide Model for Tompkins County healthcare leaders presented by Jenna Heise, Director of Suicide Prevention Implementation at the NYS Office of Mental Health’s Suicide Prevention Center of New York; and faculty member, Zero Suicide Institute.

On March 24, Tammy Weppelman, Texas State Suicide Prevention Coordinator and team lead for the Suicide Prevention Team at the Texas Health and Human Services Commission, will provide a briefing for Tompkins County frontline healthcare managers on implementing Zero Suicide protocols.

Then on June 16, Virna Little, CEO of Concert Health and a leading expert on integrating primary care and behavioral health, will provide a briefing for primary care physicians and their teams on implementing Zero Suicide protocols in primary care practices

The Sophie Fund believes that preventing suicide is an urgent priority. Over the past five years, Tompkins County has averaged 12 suicide deaths per year. Another 1,600 parents, children, siblings, friends, and spouses may be impacted by the resulting psychological, spiritual, and/or financial loss. An estimated 300 people in our community may attempt suicide every year.

Suicide is the second leading cause of death among Americans aged 10-34. While rates for other causes of death have remained steady or declined, the U.S. suicide rate increased 35.2% from 1999 to 2018. And yet, we know there is help available and treatment works when done effectively.

FULL PROGRAM UPDATE:

Understanding, Identifying, and Addressing Suicide Risk: A clinical primer for behavioral health providers, March 9, 2022

“A Model for Understanding Suicidality,” David Klonsky, PhD, University of British Columbia

“Screening and Assessing for Suicide Risk,” Lisa Horowitz, PhD, MPH, National Institutes of Mental Health

“Engagement, Lethal Means Counseling, Treatment Planning and Documentation,” Jill Harkavy-Friedman, PhD, Columbia University, The American Foundation for Suicide Prevention

“Safety Planning Intervention: A Brief Intervention for Reducing Suicide Risk,” Barbara Stanley, PhD, Columbia University, Center for Practice Innovation

“Dialectical Behavioral Therapy for Suicide Prevention (DBT-SP),” Kate Comtois, PhD, University of Washington, Center for Suicide Prevention and Recovery

“Attachment-Based Family Therapy for Suicide Prevention (ABFT-SP),” Guy Diamond, PhD, Drexel University, Center for Family Intervention Science

“Cognitive Therapy for Suicide Prevention (CT-SP),” Gregory Brown, PhD, Kelly Green, PhD, University of Pennsylvania, Center for the Prevention of Suicide

“Prolonged Grief Disorder Therapy for Suicide Loss,” Katherine Shear, PhD, Columbia University, Center for Prolonged Grief Disorder

Closing Remarks, Sigrid Pechenik, PsyD, The Wellness Institute, former director, New York State Suicide Prevention Center

Experts on the Zero Suicide Model

The Suicide Prevention Center of New York’s “AIM for Zero: Suicide Care is Healthcare” symposium September 28-30 featured 11 outstanding presentations by leading experts on the Zero Suicide Model for healthcare. The presentations covered the model’s history, evidence base, core elements, screening and assessment tools, use in primary care, emergency departments, and crisis care systems, and special implications for preventing suicide among Black adolescents, LGBTQ youth, and members of tribal nations.

DOWNLOAD Click here to download a PDF of summaries of the 11 “Aim for Zero” presentations, compiled by The Sophie Fund.

Here is a listing of the 11 individual summaries:

“Vision Zero: Eliminating Suicide & Transforming Healthcare” C. Edward Coffey, a professor of Psychiatry and Behavioral Sciences at the Medical University of South Carolina [WATCH VIDEO]

“If Preventing Suicide is Our Target, Suicide Safe Care—in all Healthcare Settings—Is the Bullseye” Michael Hogan, former New York State Commissioner of Mental Health and co-developer of the Zero Suicide Model [WATCH VIDEO]

“A National Perspective on Zero Suicide in Healthcare” Richard McKeon, Branch Chief for Suicide Prevention at the Substance Abuse and Mental Health Services Administration (SAMHSA) [WATCH VIDEO]

“Implementing Zero Suicide in Health Systems” Brian Ahmedani, director of the Center for Health Policy and Health Services Research at the Henry Ford Health System [WATCH VIDEO]

“Best Practices for Primary Care” Virna Little, Chief Operating Officer & Co-Founder of Concert Health, a national organization providing behavioral health services to primary care providers [WATCH VIDEO]

“Zero Suicide Work in Emergency Departments: Opening Pandora’s Box” Edwin Boudreaux, professor of Emergency Medicine, Psychiatry, and Quantitative Health Sciences at the University of Massachusetts Medical School [WATCH VIDEO]

“The Promise of 988: Crisis Care for Everyone, Everywhere, Every Time” [WATCH VIDEO] David W. Covington, member of the Executive Committee of National Action Alliance for Suicide Prevention

“From Equality to Equity in LGBTQ Youth Suicide Prevention” Keygan Miller, Senior Advocacy Associate for The Trevor Project [WATCH VIDEO]

“Singing in a Strange Land: Suicide Prevention for Black Youth” Sherry Molock, associate professor in the Department of Psychological & Brain Sciences at George Washington University [WATCH VIDEO]

“Making Suicide a Never Event – Zero Suicide in Indian Country” Sadé Heart of the Hawk Ali, Tribal Lead and a Senior Project Associate at the Zero Suicide Institute and former Deputy Commissioner of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services [WATCH VIDEO]

“A Zero Suicide Story” Wykisha McKinney, Zero Suicide Program Manager at The Harris Center for Mental Health & IDD (Intellectual or Developmental Disability) [WATCH VIDEO]

READ MORE: The Zero Suicide Model in Tompkins County

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.