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.

State-Local Partnership in Suicide Prevention

The Sophie Fund on Thursday applauded New York Governor Andrew M. Cuomo’s 2019 “Justice Agenda” for including a proposal to strengthen suicide prevention infrastructure through state and local partnerships.

stateofstatecuomo

“While there is much still to be done, we truly thank Governor Cuomo for his commitment to preventing suicide in our state and for taking concrete actions in order to do so,” said Scott MacLeod, a co-founder of The Sophie Fund. “The governor understands the importance of addressing this challenge at the community level and with results-oriented strategies.”

In his annual State of the State Book accompanying an address to the legislature on Tuesday, Cuomo called on New York State agencies to partner with communities in five critical areas of suicide prevention: innovative public health approaches; healthcare systems; cultural competence in prevention programming; comprehensive crisis care; and surveillance data. Under the proposal, communities that demonstrably strengthen suicide prevention infrastructure will receive a New York State designation.

MacLeod noted that recent progress in Tompkins County’s suicide prevention efforts stemmed in part from the vital support provided by the state Suicide Prevention Office and affiliated Suicide Prevention Center of New York. In July 2018, the Tompkins County Legislature unanimously passed a resolution to support the Zero Suicide Model, a pillar of the state’s comprehensive suicide prevention policy. The resolution called on local healthcare and behavioral healthcare providers to follow the model’s systematic clinical approach to preventing suicides.

The legislative act 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.

“The state Suicide Prevention Office and Suicide Prevention Center of New York have been essential partners in the formation of the Tompkins County Suicide Prevention Coalition and in assisting local stakeholders with significantly expanding suicide prevention efforts,” said MacLeod. “We welcome the opportunity under Governor Cuomo’s proposal to expand our partnership with the state.”

Cuomo’s proposal builds on the work of the New York State Suicide Prevention Task Force formed at his direction in 2017. Cuomo charged the task force with identifying gaps in programs, services, and policies while simultaneously making recommendations to facilitate greater access, awareness, collaboration, and support of effective suicide prevention activities.

According to “Justice Agenda,” the 2019 State of the State Book:

“Suicide is an enormous public health problem. Suicide is the 10th leading cause of death in the United States. According to the Centers for Disease Control, from 1999 to 2016, suicide rates in New York State rose by nearly 30 percent, while other leading causes of death such as cancer, heart disease, and motor vehicle accidents all decreased. Each year nearly 1,700 New Yorkers die by suicide.”

In 2016, the state Suicide Prevention Office released “1,700 Too Many: New York State’s Suicide Prevention Plan 2016–17.” It focused on three main areas for battling the rising suicide rate: prevention in Health and Behavioral Healthcare Settings (Zero Suicide Model); Prevention in Competent, Caring Communities Across the Lifespan; and Suicide Surveillance and Data-Informed Suicide Prevention.

Meet the Tompkins County Suicide Prevention Coalition

More than 40 local mental health leaders launched the Tompkins County Suicide Prevention Coalition at a day-long working meeting held in Ithaca Monday.

TCSPC

“It’s inspiring to see the breath of the organizations and individuals represented,” said Frank Kruppa, director of the Tompkins County Health Department. “It’s one of the things that makes Tompkins County special: when we have these types of issues, we are able to get folks in the room and talk about how we are going to tackle them.”

Deputy Commissioner of Mental Health Services Sharon MacDougall, the coalition’s organizer, said that the county seeks to foster greater collaboration in suicide prevention among the array of agencies and groups who deal with the issue.

“A coalition brings together all the experts that are in your county already,” she explained. “You have so many different perspectives, so many resources, so many different knowledge bases, and pulling them together gives you that focused lens on a community problem. We can help make that bigger effort to reducing suicide. If it is one death, it is one too many for Tompkins County. Zero suicide sounds like a lofty goal, but I think it has to be the goal.”

Garra Lloyd-Lester, associate director of the Suicide Prevention Center New York, briefed the participants on steps toward creating a successful suicide prevention coalition and presided over a Strengths-Weaknesses-Opportunities-Threats (SWOT) analysis.

“Things are off to a great start,” said Lloyd-Lester, who described the participants as “a diverse group of stakeholders, a cross section of people who are really invested in suicide prevention for the community.” But he warned that the coalition faced the critical challenge of sustaining momentum.

“At the meeting today, there was a lot of real energy, a lot of people all saying, ‘This is important work, we need to do it,’” Lloyd-Lester said. “How do you sustain that over the long haul? It’s a marathon, not a sprint. A coalition has to be built on more than just those individual champions. It’s got to be a culture, a way of doing things in the community. It takes recognition that no one entity can be responsible for suicide prevention in the community.”

Garra

Garra Lloyd-Lester, Suicide Prevention Center New York

Lee-Ellen Marvin, executive director of the Suicide Prevention and Crisis Service in Ithaca, told the gathering that while Tompkins County’s suicide rate last year was seven deaths per 100,000, the actual number of suicide deaths jumped from four in 2014 and five in 2015 to 11 in 2016. “We can’t be complacent about suicide loss,” she said.

Marvin, whose agency has spearheaded suicide prevention in the area since 1969 by staffing a crisis hotline, after-trauma services, and education programs, listed two goals she hoped the coalition would help advance. The first is better understanding of people at risk in certain communities and how to reach them—such as financially struggling young adults, middle-aged men, gun owners, drug users. The second is adoption of the Zero Suicide Initiative, a commitment to suicide prevention in health and behavioral health care systems.

“What we need to communicate is that there is hope, there is help, and that there is absolutely no shame in getting help,” she concluded.

SharonGarraLeeEllen

Sharon MacDougall, Garra Lloyd-Lester, Lee-Ellen Marvin

Agencies and organizations represented at Monday’s meeting of the Tompkins County Suicide Prevention Coalition included:

Suicide Prevention and Crisis Service in Ithaca

Mental Health Association in Tompkins County

Family & Children’s Service of Ithaca

National Alliance on Mental Illness (NAMI) Finger Lakes

Care Compass Network

The Sophie Fund

Human Services Coalition

Alcohol & Drug Council of Tompkins County

Cayuga Addiction Recovery Services

Tompkins Community Action

Planned Parenthood Southern Finger Lakes

Franziska Racker Centers

Cayuga Medical Center

The Advocacy Center

Ithaca Free Clinic

Lakeview Mental Health Services

Cornell Health

Ithaca College Office of Counseling and Wellness

Ithaca College Office of Public Safety and Emergency Management

Empire State College

Ithaca City School District

Groton Central School District

Tompkins County Legislature

Tompkins County Health Department

Tompkins County Mental Health Department

Tompkins County Office for the Aging

Tompkins County Youth Services Department

Tompkins County Department of Emergency Response

Suicide Prevention Center New York

Broome County Suicide Awareness for Families and Educators

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[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.]