The Sophie Fund is honored to become a new member in 2023 of the New York State Suicide Prevention Council.
Scott MacLeod, co-founder of The Sophie Fund, and Jay Carruthers, director of the Suicide Prevention Center of New York
The council was established in 2016 to assist the New York State Office of Mental Health “to raise awareness, reduce suicide attempts and deaths, and promote wellness among New Yorkers.” The council formed four work groups to address specific areas, including the Zero Suicide Model in health and behavioral health care, communities and coalitions, school and youth initiatives, and data and surveillance. The Sophie Fund serves on the Zero Suicide work group.
Council membership includes experts (researchers, clinicians, and state and community agencies), individuals and family members with lived experience (attempt and loss survivors), and advocacy groups and organizations.
The recent fall meeting, in Albany on November 9, featured report-outs from the work groups. Jay Carruthers, director of OMH’s Suicide Prevention Center, announced the award of a major new federal grant to the center for advancing the Zero Suicide Model across New York State. The $3.5 million grant, from the Substance Abuse and Mental Health Services Administration (SAMHSA), runs through 2028. Zero Suicide is a set of strategies and tools for suicide prevention in healthcare and behavioral health systems.
New York State Suicide Prevention Council meeting November 9, 2023
The SAMHSA grant will support the Zero Suicide framework to improve suicide care and behavioral health services generally in Certified Community Behavioral Health Clinics (CCBHC). Currently there are 13 CCBHCs in New York State, and 26 additional clinics will open by 2025.
The vision of the grant is to reduce suicide attempts and deaths among adults ages 18 and older and establish CCBHCs as the “backbone” of New York’s Zero Suicide infrastructure using a “center of excellence” model.
Carruthers also announced a $2 million, 5-year SAMHSA grant to address the “youth mental health crisis.” The goal is to expand access to mental health services for youth aged 10-21 years by increasing the number of pediatric/family practices offering the Collaborative Care Model (CoCM).
The model integrates behavioral health professionals into general medical practices to improve patient outcomes and reduce stigma related to mental health. It also increases the confidence and competence of physical health providers in treating mental health disorders.
The grant will support CoCM implementation in high needs practices that would otherwise lack resources, and provide CoCM to complex youth patients with co-existing chronic disease, trauma history, suicidal ideation or substance use disorders.
Leaders from 11 medical and service providers participated in a community town hall on September 28, sharing perspectives on suicide as a public health concern and steps being taken by healthcare providers to implement the Zero Suicide Model in their systems.
Public Health Director Frank Kruppa and Deputy Mental Health Commissioner Harmony Ayres-Friedlander
“We’re going to continue to lift the stigma off of this issue, to be able to have open conversations in our community,” said Tompkins County Public Health Director Frank Kruppa in opening remarks. The event, “How Healthcare Helps Prevent Suicides,” was sponsored by the Tompkins County Suicide Prevention Coalition and held at the Greater Ithaca Activities Center.
“We, at Tompkins County Whole Health, believe that every suicide is preventable. And we need to say that out loud and more often, and begin to figure out how to make that a reality. Nobody needs to suffer because of this issue.”
Whole Health was an early advocate of the Zero Suicide Model, an emerging standard designed to save lives by closing gaps in the suicide care offered by healthcare providers. The model provides a practical framework for system-wide quality improvement in areas including training staff in current best practices, identifying at-risk individuals through comprehensive screening and assessment, and engaging at-risk patients with effective care management, evidence-based treatments, and safe care transition.
Andreia de Lima, chief medical officer at the Cayuga Medical Center, announced that the Cayuga Health System has re-launched its program to implement the Zero Suicide Model. She explained that Cayuga Health began implementation in 2018, but the work, limited at that time to its emergency department and behavioral health unit, was disrupted by the urgent requirements of the Covid-19 pandemic starting in 2020.
Since relaunching the program, she explained, Cayuga Health has worked to obtain leadership understanding and buy-in; expand the effort across a growing healthcare system that includes Cayuga Health Partners, Cayuga Medical Associates, and Cayuga Addiction Recovery Services (CARS); and establish implementation committees and conduct organizational self-studies in the various units.
“In this second iteration, we really want to make a system effort. When you look at the data, [suicide] can happen to anyone, anywhere. Eighty percent of the individuals that die by suicide had a healthcare encounter within two months of the event. And when you look at where did they go, the majority went to the primary care office,” de Lima said.
“I tell the team, ‘This is not a sprint, this is a marathon.’ And as long as we are all moving forward at whatever speed, we are able to move forward, we will get there, all of us, one day. The important thing is to keep going, and not stop.”
If you or someone you know feels the need to speak with a mental health professional, you can call or text the 988 Suicide and Crisis Lifeline at 9-8-8, or contact the Crisis Text Line by texting HOME to 741-741.
De Lima, who spoke on a panel discussing Zero Suicide implementation, cited the creation of a Zero Suicide Steering Committee comprised of healthcare leaders across Tompkins County, and a briefing from Zero Suicide expert Brian Ahmedani of Henry Ford Health in Michigan, for helping Cayuga Health relaunch its Zero Suicide program.
Andreia de Lima, Laura Sidari, Lisa Roos, David Reetz, Jennifer Maine, and Susan Spicer
“My feeling being here is truly one of gratitude, to have the opportunity to talk about all the work that is happening in the system, that is happening in the community. I’m also feeling proud that as a county we were able to truly get together and work in such an important effort,” she said.
Laura Sidari, director of Integrated Behavioral Health at Cayuga Medical Associates, explained the importance of Zero Suicide protocols such as universal screening and care management.
“We call these mental health vital signs. Because they are just as important as getting your blood pressure done. And it gives an opportunity to have that conversation, to have that connection, should you be in a place where you’re really struggling,” she said.
“I know personally that 40 percent who died by suicide will never tell anyone, who don’t have any history of significant mental illness. This is what drives me every day. That’s really the mission of Zero Suicide, that we’re having these conversations, to prevent that 40 percent that never tell anyone,” Sidari added.
Sidari related how she was impacted personally and professionally while working as a military psychiatrist when her attending physician died by suicide. “She’s an incredible mentor, an incredible leader, had two young boys, and it was unexpected,” she explained.
“There’s a lot of work left to do. I think there’s a lot of exciting things going on in Tompkins County. I feel confident that we can make a dent in the suicide rate because it is preventable.”
Susan Spicer, director of the Tompkins County Mental Health Clinic, said that her organization established an implementation team in January that consists of clinicians, support staffers, and even administrative staff members. She said that the team completed an organizational self-study in August.
“I do want to say that the first tenet of Zero Suicide is leadership, and I have great support for implementation in Tompkins County at the mental health clinic,” she said.
Lisa Roos, nurse manager for behavioral health at the Guthrie Cortland Medical Center, said her organization has begun implementing Zero Suicide in its emergency department and behavioral health unit. She said Guthrie also embeds mental health providers in primary care settings.
Roos said that Guthrie units follow the Zero Suicide practices of providing universal mental health screening and collaborating with at-risk clients on a Stanley-Brown Safety Plan, a brief intervention that guides a user through crisis response tools.
“I wouldn’t say we’re fully implemented yet, and I can say that our leadership is completely committed to getting us there. It’s a big road for a large organization. So what we decided is to take little, manageable chunks, and try to do each of those chunks well and just keep going and growing,” she said.
David Reetz, director of Counseling and Psychological Services at Cornell University, praised the “impressive county wide initiative” on Zero Suicide but said that he was only nine months into his position and had a weak understanding of what Cornell has done to advance the model.
Nonetheless, he added, “there’s quite a few things that we do to improve suicide prevention and early intervention.” He said that students seeking health or behavioral health services at Cornell are screened with a mental health measure. He noted that his organization operates a 24-hour mental health hotline to access a provider who will do some assessment and early intervention with brief intervention strategies.
Reetz said that a current focus is improving access and awareness of services by decentralizing them—taking services out of the Cornell Health building and creating clinical spaces throughout the campus. He said that Cornell is working to reestablish a team of mental health consultants in the campus medical clinic after the model dissolved due to changing priorities during the Covid-19 crisis.
Reetz said that his biggest concern is the fate of students who are struggling but do not seek mental health services.
“I’ve been leading mental health services in higher ed for 17 years. I’ve seen that statistic over and over again, that the students that lose their lives to suicide, 90 percent plus haven’t been to a counseling center. We hadn’t seen them. The weight that I really carry are the students that we don’t see, the students that don’t come in. Access to care, to me, is the most significant barrier we have to figure out.”
Jennifer Maine, director of residential programs at the Alcohol & Drug Council of Tompkins County, said that her organization began implementing the Zero Suicide Model in its outpatient clinic in 2021.
She said the clinic did a minimal assessment for addiction treatment, but realized that it needed to conduct further screening to assess suicide risk. Clients deemed at a higher level of risk are directed into advanced assessment with a social worker or a psychiatric nurse practitioner and can receive extra support throughout their treatment including lethal means counseling and safety planning.
Maine said that a new inpatient facility enables the council to put high-risk individuals in anti-ligature rooms rather than sending them to a hospital emergency department. When clients are discharged from the inpatient facility, a clinician will ensure they are connected to appropriate onward services.
Kari Burke, coordinator for Health Services and Wellness in the Ithaca City School District, was among five mental health leaders who provided perspectives on why suicide is a public health issue of concern to all.
Erica Cotraccia, Tiffany Bloss, Kaitlynn Tredway, Kari Burke, and Deb Maxwell
She said that suicide prevention is an integral part of the district’s mental health efforts, supported by school psychologists, social workers, counselors, and health professionals co-located with school nurses.
She explained that an important part of prevention is creating a “culture of connectedness” through social emotional learning.
“We have work that we’re doing, again, at a preventive level, around social emotional learning where we’re having or asking young persons to engage with and think about their feelings and emotions. The idea is to create a culture of connectedness,” Burke said.
“We want students and caregivers to be seen, heard, and known. It’s the everyday interactions. Identifying students by name, by their pronouns. Knowing something about them beyond how they grade, how they test. And I think increasingly it’s about getting those who don’t hold a social worker license or have a school psychologist training background to recognize that this is part of their role,” she said.
Kaitlynn Tredway, Community Engagement & Partnership Coordinator at the Syracuse Veterans Affairs Medical Center, said that Zero Suicide is part of the VA’s suicide prevention policy.
She said that VA prevention efforts focus on three areas specific to veterans: connecting with veterans and their families in the community; screening for suicide and providing evidence-based treatments; and improving lethal means safety.
“A lot of our veterans come into the military with a vision, a purpose, a mission to serve their country. When they get out of the military, a lot of times they lack that mission, that purpose. And so a lot of what we’re doing is educating on how important it is to have that mission and that purpose when we’re transitioning,” Tredway said.
Tredway noted that while suicide rates are increasing in the general population, the rates are rising higher and faster in the veteran population. She works in 13 upstate New York counties, engaging with veterans and their families, and partnering with veteran-serving stakeholders and other organizations such as the Tompkins County Suicide Prevention Coalition.
“We at the VA hold this belief to be true, that suicide is preventable on an individual and on a community level. We know suicide prevention will require all of us to be collectively and uniquely engaged with the unifying and overriding goal towards ending veteran suicide.”
She said that compared to fielding 6,200 calls in 2022, her organization had taken more than 9,300 calls so far in 2023.
“It’s a big increase and you’ll get calls from as young as seven years old, up to 99 or 100. A majority of our population is 65 and older. There are a lot of struggles there,” she explained.
Bloss said that SPCS inaugurated a 24-hour warm line in March, to provide a discrete pathway for people who were not in a suicidal crisis but still felt the need to speak with a counselor.
“It really speaks to the prevention that we needed to do for the community, and allow people that space to get human connection when they weren’t in crisis and prevent them from getting into crisis,” she said. Without actively promoting the warm line, nearly 700 people a month are calling in, she said.
Bloss said that as part of SPCS’s recent rebuilding effort its counselors go through 200 hours of training before they take calls on the 988 line.
“These are pretty serious conversations that they’re having with folks on a daily basis. So we focus really hard on that de-escalation for folks, keeping them safe where they are. A lot of people are really scared that when you call 988, we’re going to call 911 and connect you with the police. That does not happen. It’s less than two percent of calls around the country that are connected to emergency services,” she said.
Bloss said that SPCS also performs community education and training, through a menu of programs and workshops.
“We’re trying to make people more comfortable with talking about suicide, to have that conversation with folks. We teach you how to do that. How to look for those signs that someone is struggling and having thoughts of suicide, how to ask very directly and then what to do when you have that answer.”
Erica Cotraccia, director of the CARS outpatient program, said that her organization is working on integration within the expanding Cayuga Health System.
She said that CARS clinicians conduct screening for suicidal ideation, and provide clients with safety plans and information on what to do in a crisis outside CARS work hours.
Cotraccia said that CARS clinicians are trained to be comfortable having difficult conversations with clients.
“This is a really such an important topic for people who feel helpless, who feel a lot of shame, who feel a lot of guilt. We’re able to be a voice to them, when a lot of people don’t feel like they have a voice in society, and the population of people who are using substances feel like as a whole that they are not being cared about. So they come to us and they are looking for that support. And for us to be people to listen to them,” she said.
Deb Maxwell, founder of Smile Through the Storms, wrapped up the town gall with the story of how she created a support group for suicide loss survivors in memory of her son, David “Bubbie” Shugart.
“One of my survivors mentioned that we’re the collateral damage. We’re what’s left. We pick up the pieces. When I lost my son back in 2014, there was nobody. I said, this can’t be right. I can’t be the only one who feels this way,” she said.
Maxwell established and operates Smiles with two group sessions a month at her Elmira home, welcoming in-person survivors as well as participants on Skype from New York to California and Canada down to Texas.
“We bond together. It’s a safe spot. We can talk. We share. There’s no judgment. And we help heal each other. I’m my son’s voice now. I’m not going anyplace. I’m going to keep sharing this information about suicide awareness, suicide prevention. It’s not what I wanted to do. It’s not what I dreamed to do. Oh, by God, it’s what I do now,” she said.
The town hall was supported by a grant from The Sophie Fund.
A top New York State mental health official on September 19 praised Tompkins County’s “outstanding commitment to suicide prevention,” noting the strides made by its healthcare providers to implement the Zero Suicide Model.
Jenna Heise, director of Implementation at Suicide Prevention Center of New York
“Tompkins County has proven itself as a strong partner in the ongoing collective efforts to prevent the loss of lives due to suicide and promote mental health for all community members,” said Jenna Heise, director of Implementation at the Office of Mental Health’s Suicide Prevention Center.
“Tompkins County’s persistence and dedication to implementing the Zero Suicide Model has set an important precedent, not only within your community but across the broader suicide prevention landscape. I’m delighted to acknowledge and celebrate Tompkins County’s outstanding commitment to suicide prevention and the strides made in advancing the Zero Suicide Model locally,” said Heise in a message to the Tompkins County Suicide Prevention Coalition.
Zero Suicide is an emerging standard designed to save lives by closing gaps in the suicide care offered by health and behavioral health providers. The model provides a practical framework for system-wide quality improvement in areas including training staff in current best practices, identifying at-risk individuals through comprehensive screening and assessment, and engaging at-risk patients with effective care management, evidence-based treatments, and safe care transition.
Heise praised plans for a September town hall in Ithaca, organized by the Suicide Prevention Coalition, to update the community on the suicide prevention efforts.
“Such events are critical for engaging the general public, raising awareness about suicide prevention, and fostering a platform for meaningful discussions. We believe that engaging the community is paramount and applaud Tompkins County’s proactive approach. The collaborative nature and passion exhibited by Tompkins County is inspiring,” Heise said.
If you or someone you know feels the need to speak with a mental health professional, you can call or text the 988 Suicide and Crisis Lifeline at 9-8-8, or contact the Crisis Text Line by texting HOME to 741-741.
The Tompkins County Suicide Prevention Coalition will host “How Healthcare Helps Prevent Suicides,”a community town hall to discuss local efforts to implement the “Zero Suicide” model for improving healthcare support for at-risk individuals.
The town hall, at the Greater Ithaca Activities Center (GIAC) on September 28from 5:30 p.m. – 7:30 p.m., will feature panel discussions about why suicide is a public health challenge and how the Zero Suicide model is used by healthcare systems to prevent suicide deaths.
Whole Health Commissioner Frank Kruppa will kick off the town hall with opening remarks.
Organizations serving as presenters and panelists include: Tompkins County Mental Health Services; Cayuga Health System; Cayuga Medical Associates; Guthrie Medical Group, Cortland; Cornell University; Ithaca City School District, Alcohol and Drug Council; U.S. Department of Veterans Affairs; Suicide Prevention & Crisis Service (988 Call Center); Cayuga Addiction Recovery Services; Smile Through the Storms; and The Sophie Fund.
In addition, Coalition work groups will give brief presentations on their work to improve suicide data collection and analysis, prevent suicides among young people, and reduce access to lethal means within at-risk populations.
Several local mental health agencies and organizations will provide information tables with staff who can answer questions. They include: Tompkins County Whole Health; Tompkins County Office of Veterans Services; U.S. Department of Veterans Affairs; Mental Health Association in Tompkins County; Suicide Prevention & Crisis Service (988 Call Center); American Foundation for Suicide Prevention Greater Central New York; and the National Alliance on Mental Illness Finger Lakes.
Zero Suicide is an emerging suicide prevention model designed to save lives by closing gaps in suicide care in healthcare as well as behavioral health settings.
The model calls for systematic use of screening for self-harm, safety planning for patients deemed at risk, referrals to appropriate levels of further care, safe transitions of care between providers, and evidence-based treatment for suicidality, among other tools.
“We recognize the critical role of healthcare in preventing suicide deaths,” said Zoe Lincoln, Whole Health Planner with Tompkins County Whole Health and Coordinator of the Tompkins County Zero Suicide Steering Committee, a collaborative group of local healthcare leaders. “The Town Hall highlights county-wide dedication to saving lives through evidence-based best practices, via the Zero Suicide Model. Together, we strive to elevate the standard of care and support for our community members in need.”
Implementation of Zero Suicide across local healthcare is one of the objectives listed in the Coalition’s 2022-2025 Strategic Plan. In 2022, leaders from community and campus healthcare providers formed the Tompkins County Zero Suicide Steering Committee to lead and coordinate efforts.
The Tompkins County Suicide Prevention Coalition was formed in 2017 and is comprised of health agencies, community organizations, and individual members who share a determination to prevent suicide deaths in the community.
“We are excited to present this Town Hall with a focus on Zero Suicide,” said Sally Manning, Racker Program Director and convenor of the Coalition. “We recognize suicide as a serious public health concern. The Coalition has a vision for our community where no lives are lost to suicide. This is a chance to learn more about suicide prevention and what we can all do to help those who may be struggling.”
The Sophie Fund has encouraged Tompkins County providers to work toward implementing the Zero Suicide model, beginning with a presentation by leading experts for healthcare leaders in October 2017. The Sophie Fund then sponsored a series of five presentations and trainings on Zero Suicide for healthcare leaders and clinicians in 2021-22.
A top expert urged Tompkins County healthcare leaders on August 9 to pursue implementation of the Zero Suicide Model, a framework designed to prevent suicide deaths by closing gaps in the care provided by healthcare systems.
Brian Ahmedani, suicide prevention expert at the Henry Ford Health System
Brian Ahmedani, director of the Center for Health Policy & Health Services Research at the Henry Ford Health System, said Zero Suicide has proved to be highly effective in Henry Ford’s pioneering work on the model over the past two decades. During a period between 2008 and 2010, he said, not a single Henry Ford behavioral health patient died by suicide.
Citing the continuing rise in the U.S. suicide rate in the past 20 years, Ahmedani said research now shows that healthcare systems can play an important role in reversing that trend..
“We need to do something about this, and the time is now,” he said. “So your charge is to map out a perfect system of care, develop processes and policies that align with that perfect system of care, and figure out who is going do each part of that system of care.”
Ahmedani made his remarks in a presentation to the Tompkins County Zero Suicide Steering Committee, a group of healthcare leaders formed in 2022 to work on implementing the model within and across healthcare systems serving the community. The presentation was sponsored by The Sophie Fund.
Ahmedani explained that the Zero Suicide model for healthcare as well as behavioral health settings entails patient screening, risk assessment, and care coordination.
It starts with systematic screening of all patients using evidence-based tools to determine if they have any suicide risk. If a patient screens positive, then a risk assessment is conducted to determine the onward care that is aligned with their level of risk. Zero Suicide calls for care coordination to avoid system gaps, and for the use of evidence-based treatments for suicidality such as Cognitive Behavioral Therapy.
Ahmedani said that the model calls for the provider and an at-risk patient together to develop a safety plan, a quick guide to help in a crisis that includes their personal warning signs, coping strategies, emergency contacts, and reminders of how to stay safe away from lethal means. Just the safety plan along with a follow-up caring contact message with a patient reduces suicide risk by 20 percent, he said.
“When somebody has suicidal ideation, it’s sort of like having paralysis of your brain, your body shuts down and it can only think of this escape pathway. So if you have a rehearsed plan, they know what they can do instead. If they don’t have a plan, that’s when they continue to get stuck in this this fixation when this intense wave of wanting to hurt yourself comes over your brain and takes over,” he said.
Explaining Zero Suicide’s inclusion of healthcare settings, Ahmedani noted that until 2012 conventional wisdom felt that suicide prevention was a mission left to the behavioral health field.
But he said that research indicates that more than 83 percent of people who died by suicide had made some type of healthcare visit in the weeks and months prior to their death; 92 percent of people making a suicide attempt had seen a healthcare provider very recently. Moreover, he added, studies now show that more than half of the people who die by suicide had no mental health diagnosis.
“That means they’ve never received psychotherapy, they’ve never come in for a suicide attempt in the past, there is no evidence of mental health diagnosis in their entire clinical history,” Ahmedani said.
“What that means is that we need different approaches for suicide prevention. We can’t just rely on waiting for someone to get a mental health diagnosis before we think about suicide prevention. Most people are connecting with healthcare systems before they’re dying. They’re right in front of us.”
Ahmedani said that primary care practices are an important setting for identifying people at risk who may never have sought mental health treatment.
“Most people are actually going to primary care before they’re dying by suicide. If we don’t do anything in primary care, we won’t be able to reach the vast majority of people who are right in front of us before they’re dying by suicide.”
Ahmedani said that behavioral health settings continue to be critical for preventing suicide, because patients with a mental health diagnosis are already known to be at an elevated risk. “But even if we provided perfect care in behavioral health, we could only reach about one third of the people who are dying by suicide,” he said.
Another argument for all healthcare settings also playing a role, Ahmedani said, is a realization that suicidality is not a symptom of a disease like depression but is actually its own disease that needs to be identified and treated as a comorbid condition.
“We really need to think more broadly than that it’s just some symptom of depression or symptom of substance use or symptom of something else, and that if we treat that thing then the suicide risk will go away. We actually have to treat those things concurrently. Both things need to be treated,” he said.
Ahmedani said that unlike longstanding strides to prevent cardiovascular disease, most of the effective interventions outlined in the Zero Suicide Model have only been developed by Henry Ford and others over the past two decades.
“The interventions really haven’t penetrated healthcare systems in the way that other disease treatments have,” he said. “But we have an opportunity to do that now. So I’m really encouraging us to think about how we can take advantage of it,” he said.
“This program is set up perfectly to structure within a healthcare system using pragmatic approaches and interventions that fit within healthcare so they don’t overburden the resources and staffing and all the costs. It is designed to work effectively in your program.”
Ahmedani stressed the importance of creating a healthcare system team to lead implementation of Zero Suicide, as they did in pioneering the model at Henry Ford.
“Our major recommendation is that you start and launch these services with a team of people that can represent the different perspectives in your healthcare system,” he said. Henry Ford’s team included system leadership, clinicians from different levels, and patients “so that we could really design a system of care that works for everybody,” he said.
Creating system teamwork to prevent suicide deaths removes a burden of responsibility from “the individual heroic clinician who works 24 hours a day, seven days a week trying to stay up and do all these things,” he said. “If we work as a team, we can reduce burnout, we can be more effective, and we can deliver services that end up leading downstream to a better result in preventing suicide.”
Ahmedani said that after implementing Zero Suicide’s quality care process improvements, Henry Ford saw a 75-80 percent reduction in suicide deaths among behavioral health patients within the first year. He said that reduction would then be sustained for more than 22 years even as the U.S. and Michigan suicide rates continued to climb; during an 18-month period from 2008-2010, no behavioral health patients died by suicide.
“Without doing all these things, people fall through the cracks. People aren’t identified, they see multiple providers most of the time, they interact with our healthcare system in lots of different ways, and we don’t figure out who they are. If we do each of those processes, people don’t fall through the cracks,” he said.
“We’ve got a lot of data that show that this program works not only at Henry Ford but it works at a lot of different health care systems. The goal of Zero Suicide is that, instead of thinking that suicide is inevitable like we used to, we’re now thinking suicides are preventable.”
To the surprise of many, Ahmedani said, Henry Ford increased its behavioral health revenue eight-fold after implementing Zero Suicide by reformatting and restructuring the way that it provides care.
He said that medical practices utilizing collaborative care models are able to bill insurance for suicide prevention procedures like screening, risk assessment, and care coordination. He said Blue Cross in Michigan is leading a partnership with healthcare incentivizing or paying for suicide prevention procedures.
Ahmedani said about 50,000 people die by suicide in the United States each year but that the scope of the problem is even bigger. He said 2 million people in the U.S. make a suicide attempt every year, and 15 million are thinking about suicide at some point in the year.
“So we’re talking about somewhere between 4-5 percent of the U.S. general population who are affected by suicide during a year. That’s a lot of people,” he said.
He said that suicide is the only one of the 15 leading causes of death in the United States whose annual rate has been increasing. The annual rate increased 25-30 percent over the past two decades, he said.
Ahmedani said that a significant step forward occurred with the release of the 2012 National Strategy for Suicide Prevention, which drew on Henry Ford’s work and for the first time declared that suicide prevention should be a core component of healthcare services and not only behavioral health.
Afterwards, The Joint Commission, a leading healthcare accrediting body, issued recommendations for preventing suicide in healthcare settings and requirements for using the latest processes and intervention tools in behavioral health settings.
Ahmedani noted that some people in healthcare get “twitchy” about the seemingly unrealistic notion of aiming for zero suicide deaths. “The long-term aspirational goal is to prevent every suicide, but the operational goal is to implement a system of care that focuses on error reduction,” he explained.
He noted that “designing for zero” is a practice seen in many areas, such as surgical operating theaters, airline travel, automotive manufacturing, and nuclear power plants. Setting a goal of zero suicides maintains a focus on continuous quality improvement, he said, reducing the opportunity for complacency. “If we strive for any other number, then we aren’t moving towards the ultimate goal,” he said.
Ahmedani serves as chair of Michigan Governor Gretchen Whitmer’s Suicide Prevention Commission. Besides his work on Zero Suicide at Henry Ford, he is a principal investigator for a number of current clinical trials and studies around suicide and healthcare; one of them is evaluating the implementation of the Zero Suicide Model in various settings of six healthcare systems in five states serving 10 million patients a year.
The creation of the Steering Committee was a response to Goal 2 of the Tompkins County Suicide Prevention Coalition’s Three-Year Strategic Plan 2022-2025 adopted in February 2022. One of Goal 2’s objectives is to “form a Zero Suicide Work Group comprised of leading health and mental health providers to share ideas, experiences, and challenges, and lead collaborative, sustainable efforts to implement the Zero Suicide Model throughout Tompkins County.”
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