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.

Thank You for Your Service

By David Shapiro

Thank You For Your Service, the 2016 documentary by Tom Donahue, opened my eyes to the mental trauma that our military veterans can fall victim to. Among the shocking realities highlighted by the film is that 20 veterans take their own lives every day in the United States. Thank You for Your Service goes beyond the statistics to reveal the failed mental health policies within the U.S. military.

It is a privilege for Family & Children’s Service in Ithaca to share this important movie with our community and participate in advocacy for improved mental health care for our veterans and active service men and women. The screening of Thank You For Your Service at Cinemapolis on May 17-18 is sponsored through Family & Children’s Pamela and Robert Swieringa Education Center, carrying on a tradition we began last year in using cinema as a powerful public educational platform during Mental Health Awareness Month.

Thank You for Your Service features all manner of players and experts discussing the mental health crisis in the U.S. military, including former Defense Secretary Robert Gates, ex-CIA chief David Petraeus, and war correspondents like Sebastian Junger and Dexter Filkins. But most importantly, the film gives voice to the voiceless veterans themselves. The Hollywood Reporter aptly summarized the story in its review of Thank You for Your Service:

The interview subjects all agree that the Defense Department and the Veterans Administration have not sufficiently attended to veterans’ mental health needs, and the problems they cite are numerous. Among them are bureaucratic inefficiencies, lack of funding, the overprescribing of psychotropic medications, a lack of qualified therapists, and extended tours of duty that result in soldiers serving far longer than they bargained for.

But it’s not the expert commentary, as illuminating as it is, that gives the film its power. Rather, it’s the handful of veterans who discuss their emotional struggles, both while serving in Iraq and Afghanistan and after their discharge. One describes watching his best friend being burned alive, while another relates how he felt so guilty over civilians killed as a result of his actions that he attempted to find their family members to apologize. They talk about suffering from nightmares and PTSD; resorting to drugs and alcohol to numb the pain; and, in one case, playing Russian roulette.

Thank You for Your Service has won awards, but its producers are determined to achieve something else: change. They are urging movie-goers to take action in support of a proposed Behavioral Health Corps in the armed services that would focus on addressing critical mental health needs.

“If the public takes one message away from this film: reach out to your member of congress and request that they support a behavior health corps in the military,” says Daniel Rice, president of the Thayer Leader Development Group. “That will be the best action that they can take to help address the plague of suicides that our veterans are suffering.”

David Shapiro is chief executive officer of Family & Children’s Service in Ithaca

Cinemapolis Program Details:

May 17: Film at 6:30 p.m., Panel Discussion at 8:30 p.m.

May 18: Film at 7 p.m.

Also in Mental Health Awareness Month:

Family & Children’s Service Annual Celebration

Honoring:

Adga Osborn Award recipient Joan Jacobs Brumberg

Family Partner of the Year Serendipity Catering

Volunteer of the Year Bert Odom-Reed

Guest Speaker:

Karl Pillemer

Director of Bronfenbrenner Center for Translational Research.

Tuesday May 16

8-9:30 a.m.

Ithaca Country Club

189 Pleasant Grove Road

Click here to purchase tickets

Talking About Resilience

The Sophie Fund attended the Annual Meeting and Celebration of the Family & Children’s Service of Ithaca on May 19.

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Building resilience was the theme of remarks by Greg Eells, director of Counseling and Psychological Services at Cornell University, and David Shapiro, F&CS’s president and CEO. Here are Shapiro’s remarks:

I’d like to spend a few minutes talking with you about some of the work being done at Family and Children’s Service. Last year I talked about meaningful connections and the relationship that exists between meaningful connections and happiness. Having people in your life you can trust is also an important part of being able to bounce back when under duress, or soldier on when times are tough. What I’m talking about is resilience and how important it is for us to build relationships as a part of building resilience in ourselves.

I want to tell you about some of the different ways Family and Children’s Service is connected within the community in ways that help foster resilience.

First, with Cornell. Each year hundreds of students, faculty and staff come to F&CS seeking support. Our relationship with Cornell’s Student Health Center, Gannett, is so strong and longstanding that students seamlessly transition from receiving on campus services into our community based mental health clinic. As Gannett continues to expand their behavioral services­—to extend more access to their growing student base—I know that we too will be called upon to respond to those same needs.

Second with the United Way. Last year the United Way of Tompkins County provided $127,000 in annual support for our counseling, psychiatric and rural outreach services. Because of this support Family and Children’s Service` provides counseling and psychiatry services to people without insurance and, more often, under-insured clients with out of pocket costs that would otherwise be too significant to bear. The United Way also supports our rural outreach services which provide mentorship in rural communities to youth and adolescents in need of social, emotional and behavioral support.

More than a decade ago, Family and Children’s Service collaborated with Cayuga Medical Center and the Tompkins County Mental Health department to bring child psychiatry to our community. Alone, bringing this resource into Tompkins County demonstrated the importance of this connection. But together this partnership has meant so much more to our community, as vulnerable children are discharged straight from CMC’s behavioral unit, into F&CS’s mental health clinic ensuring the needs of these kids don’t fall through the cracks. Cayuga Medical Center has also been an important partner along with the City of Ithaca, Downtown Ithaca Alliance, Ithaca Renting Company and Tompkins County in providing outreach services in our downtown business district.

Tompkins County also enables F&CS to support some of the county’s most vulnerable youth by providing funds that support the specialized clinical and case management programs offered by F&CS that focus on improving social, emotional and behavioral development needed by:

—Children, younger than 5 years old often who have already been exposed to violence, addiction, poverty and despair.

—Adolescents and teenagers facing immediate mental health crises.

—And more youth and adolescents, at risk of being removed, running away from their home, or sometimes already having left and are now homeless.

—And aging adults, looking to strengthen their support system so that can age gracefully in their homes.

These are just examples of some of the important community connections that exist in order for F&CS to advance our mission. There are so many more.

Tompkins County is blessed with an abundance of community organizations and social supports for people in need. However, I want to challenge us to think about these services in a broader context that looks not just at whether the services exists, but also asks if there meaningful ways for these services to connect around a common good.

The truth is, in a fast paced, technologically driven world, many people are finding it more and more difficult to build meaningful connections and are forced to face the world alone. And just like each of us individually needs each other to support one another, as an organization we need to build connections too if we want give our clients the best chance at success.

To borrow a quote from Hellen Keller, “alone we can do so little, together we can do so much.” Thank you for being here, together, with me today. Each time we come together around a common good, we grow as a community and are better prepared to face the challenges ahead of us.