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.”