New Step Toward “Zero Suicide” in Tompkins County

Top healthcare leaders in Tompkins County have agreed to form a steering committee to drive local implementation of the Zero Suicide Model, an emerging standard designed to save lives by closing gaps in the suicide care offered by and across healthcare providers.

Zero Suicide roundtable participants, July 20

The move came during “Zero Suicide Roundtable: A Discussion on Best Practices in Suicide Prevention with Tompkins County Healthcare Leaders,” hosted on July 20 at the Statler Hotel by The Sophie Fund and Tompkins County Mental Health Services.

The two-hour roundtable was moderated by Jenna Heise, director of Suicide Prevention Implementation at the Office of Mental Health’s Suicide Prevention Center of New York.

The 13 roundtable participants represented Cayuga Medical Center, Guthrie Cortland Medical Center, Tompkins County Health Department, Tompkins County Mental Health Services, Family & Children’s Service of Ithaca, Suicide Prevention & Crisis Service, Cornell University, Tompkins Cortland Community College, and The Sophie Fund.

The leaders’ agreement is a step toward fulfilling Goal 2 of the Tompkins County Suicide Prevention Coalition’s 2022-2025 Strategic Plan, adopted last February, which calls for “quality improvement for suicide care in all Tompkins County healthcare and behavioral health settings.”

The strategic plan’s Objective 2.3 calls for the formation of 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.”

Harmony Ayers-Friedlander, deputy commissioner of Tompkins County Mental Health Services, introduced Heise to the gathering “as we renew our commitment to the implementation of the Zero Suicide Model in our community, within, and across, our healthcare settings.” She noted that the county’s Suicide Prevention Coalition was launched exactly five years earlier with the vision of “a community where no lives are lost to suicide.”

Addressing the healthcare leaders, Ayers-Friedlander added:

“Your presence here today serves as a reminder of just how important this work is. Zero Suicide works. Because it gives us hope that we can make a difference, direction through a systems-based framework when faced with the complexity of human suffering, and real tools that help us at each step of the way. Today is a time to evaluate where we are individually as institutions and collectively as a community in preventing suicide through this model.”

Jenna Heise, director of New York State’s Suicide Prevention Implementation, moderates a Zero Suicide leadership roundtable

Heise opened the roundtable with a brief overview of the Zero Suicide Model and then walked participants through a discussion on the model’s seven elements: leadership, training, screening and assessment, care planning, treatment, transition of care, and quality improvement.

“The foundational belief of Zero Suicide is that individuals in our care, on our watch, need not die by suicide, and that suicide is actually preventable for those in care,” Heise said. “The way that happens is that suicide prevention and suicide care become a core priority for health and behavioral health. We have not done a good job of that, frankly.”

“We need to have that leadership commitment,” Heise said. Under the model, she explained, a leadership commitment creates a “just culture” for suicide care that relies on systemic use of best practices rather than leaving suicide prevention to individual health workers.

“It has to be looked at as a systems problem,” she said. “For too long, we have left it to the crisis team or to one outstanding individual clinician or social worker, and our systems, or the newest person, the greenest person straight out of school, who had no schooling in suicide.”

Citing examples of successful implementation of Zero Suicide, such as in the Henry Ford Health System in Michigan, Heise added: “It is an aspirational goal but it is quite attainable. There are folks that have done this work and committed to it, and followed this framework in implementing the seven elements, and they have shown that you could significantly reduce the suicides, by rate and number, within your healthcare organization.”

Heise commended Tompkins County’s approach to creating a “safer suicide community, wrapped around health and behavioral healthcare, including partners on board like the health department, behavioral health, large health systems, universities, higher ed, and so forth. That’s where you start to really see impact, everybody speaking the same language, using the same tools, the same best practices, the same framework. This is very exciting.”

Participants shared their experiences with various aspects of suicide prevention measures within their systems. They noted the importance of cross-system coordination and integration for suicide care, the challenge of staffing, and a desire for greater suicide-specific training. Several participants noted their continuous quality improvement efforts in suicide care but said they did not follow the Zero Suicide Model per se.

The Sophie Fund provided participants with a packet of materials about the Zero Suicide Model and previous suicide prevention efforts that have been undertaken in Tompkins County. The packet included the following items:

Zero Suicide Organizational Self-Study

Transforming Systems for Safer Care

Quick Start Guide to Getting Started with Zero Suicide

“Vital Signs: Suicide rising across the US,” Centers for Disease Control and Prevention

“Changes in Suicide Rates United States, 2018–2019,” MMWR, Centers for Disease Control and Prevention

Sentinel Event Alert Issue 56: Detecting and treating suicide ideation in all settings, The Joint Commission

National Patient Safety Goal for suicide prevention, The Joint Commission

Three-Year Strategic Plan 2022-2025, Tompkins County Suicide Prevention Coalition

Resolution 2018-155, Suicide Prevention Coalition Zero Suicide Initiative, Tompkins County Legislature

The Watershed Declaration

Mental Health Support and Crisis Services Tompkins County, The Sophie Fund

“Health Care Contacts in the Year Before Suicide Death,” Journal of General Internal Medicine, by Brian K. Ahmedani, et al.

“Suicide Prevention: An Emerging Priority For Health Care,” Health Affairs, by Michael F. Hogan and Julie Goldstein Grumet

The roundtable was the fifth and final session of a Zero Suicide initiative launched by The Sophie Fund last November. 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.

“Understanding, Identifying, and Addressing Suicide Risk: A Clinical Primer for Behavioral Health Providers,” on March 9 by The Wellness Institute

“Implementation of Zero Suicide,” a suicide prevention presentation for front line managers, on March 24 by Tammy Weppelman, State Suicide Prevention Coordinator at the Texas Health and Human Services Commission.

“Zero Suicide: Best Practices for Primary Care,” on June 16 by Virna Little, Co-Founder and CEO of Concert Health.

If you or someone you know feels the need to speak with a mental health professional, you can contact the National Suicide Prevention Lifeline by dialing 988 (or 1-800-273-8255), or contact the Crisis Text Line by texting HOME to 741-741.

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.

[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.]

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.