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.”

Tiffany Bloss is executive director of the Suicide Prevention & Crisis Service of Tompkins County, which serves as a 17-county regional call center for the 988 Suicide & Crisis Lifeline.

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.

Download a packet of materials from Town Hall: How Healthcare Helps Prevent Suicides