ZERO SUICIDE: A PRACTICAL APPROACH TO SUICIDE CARE
“The death rates for eight of the 10 leading causes of death have decreased significantly, but not for the 10th leading cause–suicide…I’m adding my voice to a growing chorus determined to make suicide a national priority.” Linda Rosenberg, January 14, 2014
Whether we work in suicide prevention, or play leadership roles in behavioral health care, we applaud Linda Rosenberg’s forthright, personal and passionate leadership on this issue. And, in thinking about our own programs, we probably would agree that suicide is the worst possible outcome for people in our care. Suicide is a largely preventable kind of death. But, what have we done to make suicide prevention an explicit part of our work?
It’s time to act on our beliefs and commitments. Did you know?
- Based on data from at least two states, suicide deaths among people who received care in the behavioral health system represent about 25% of all suicide deaths. (If these results generalize nationally, that would represent 10,000 deaths.)
- The first systematic effort to eliminate suicide in a health care system (one measure of Henry Ford Health System’s Perfect Depression Care effort) resulted in reducing the suicide death rate by over 75%.
- A practical approach to suicide care, called “Zero Suicide” or “Suicide Safer Care” has been developed and proven feasible in community behavioral health and integrated care settings.
Given this data and the feasibility of good suicide care, it is time for behavioral health leaders to lead on suicide prevention. For many years, the fields of health care and suicide prevention were strangely disconnected. In mainstream healthcare settings, the implicit message was “don’t ask, don’t tell.” In behavioral health, we have always known that suicide was a risk. But in many settings, if people admitted to intense suicidality they were quickly transferred to crisis or inpatient settings. Risk assessed, risk “managed.” But we now understand that hospitalization—while sometimes necessary—is often aversive. Furthermore, since suicidality is seldom explicitly treated during hospital stays, we are temporarily containing suicide risk rather than resolving it. We can do better.
To lead, we have to try another way. The updated National Strategy for Suicide Prevention (2012) adds a new National Goal: “Establish Suicide Prevention as a core responsibility of health care.” This means us. Leading on this issue means that working with suicidal people has to become a core competency of community care.
David Covington and I were privileged to co-lead the Clinical Care Task Force of the National Action Alliance on Suicide Prevention. We were committed to the issue, but not really prepared for what we would discover. In the past 10-15 years—and long after many of us were initially trained—new resources for suicide care have been developed:
- Reliable tools for screening and assessing suicide risk now exist that—like actuarial tools to assess forensic risk—are superior to clinician judgment alone;
- Research-informed clinical approaches now exist to help people manage their suicide risk (e.g., Safety Plans) and their suicidality (e.g. Collaborative Assessment and Management of Suicidality—CAMS);
- While legislative approaches to restrict access to means (e.g., “gun control”) remain so contentious they are near impossible, personalized means restriction or reduction with suicidal people is effective and acceptable;
- Timely, personal contact with people during periods of risk or transition is proven effective; peer supports also work in suicide care.
In short, we now have evidence that the elements of Suicide Safer Care are effective. Leading clinical organizations like Centerstone and the Institute for Family Health have proven that implementation in real world settings is feasible. Leading software vendors are developing or have already developed suites of tools to support the work. The tools and supports for implementation are available—mostly free—at www.zerosuicide.com, provided by the Suicide Prevention Resource Center.
And although we are early in this work, early adopters of this approach are seeing death rates from suicide among their consumers drop 30-60%.
The catalyst for change that we need now is your commitment to act. There are champions in your organizations who are ready to support and lead your efforts. It is better to lead than lag. The National Council is providing the key resource that you need to get started by offering a the Zero Suicide Approach: Providing Suicide Safer Care in Health Care Settings Preconference University on April 19, 2015 in Orlando immediately before the 2015 National Council Conference.