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Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

Making Health Care Suicide Safe: Join the Movement Today!

September 14, 2018 | Suicide and Addiction | Comments
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Care for suicidal people simply needs to be safer and it should feel like care. Suicide is a leading cause of death in the United States and we are failing those who need our help. We’re not training health care practitioners in suicide risk and prevention and we’re not prioritizing suicide as a central focus in health or mental health. We can do much, much better.

To find out how, I spoke to three National Council members – David Covington, LPC, MBA, president and CEO of RI International and a co-founder of the Zero Suicide campaign; Centerstone in Nashville, Tenn.; and Coleman Professional Services in Kent, Ohio.  What I learned from these suicide prevention innovators should give us all hope as we observe National Suicide Prevention Week.

From Staff Training to Systems Change

The concept of “zero” in quality improvement has been around for 50 years, with James Halpin introducing the zero defects movement in 1966. By 1976, the concept of zero had moved to reducing accidents in Japan. And, more recently, “Innovating to Zero” has been called one of the 10 megatrends for innovation (2012). In the 1980s, Don Berwick, M.D., and the Institute for Healthcare Improvement reached out to NASA with one small step for health care.

The rest is history. The Henry Ford Health System in Detroit brought zero to suicide prevention and set this ambitious goal as its key metric in creating “perfect depression care.” Beginning in 2001, they standardized assessments, trained everyone from clinicians to front desk staff, implemented evidence-based suicide prevention practices and tracked outcomes. The result was an 80 percent reduction in suicide that was maintained for more than a decade, including one year (2009) when they achieved the goal of zero suicides among individuals being treated for a mental health or substance use problem.

When the National Action Alliance for Suicide Prevention was formed in 2010, David and Mike Hogan, Ph.D., former New York State commissioner of mental health and founder of Hogan Health Solutions, examined the Henry Ford model and suicide prevention efforts conducted by the U.S. Air Force. They discovered the importance of widescale systems change and Zero Suicide was born.

A Changing Philosophy

Zero Suicide is both an aspirational challenge and a way forward. The Zero Suicide Toolkit and Zero Suicide Academy walk organizations through a seven-step process of organizational change. For those who have taken the leap, benchmarking to zero “begins with a philosophy that you can make an impact,” said Sandy Myers, M.A., LPCC, senior vice president of clinical operations at Coleman Professional Services. Over the past five years, the percentage of suicide deaths of all people served at Coleman decreased by 7 percent, compared to the previous five years.

Centerstone, one of the nation’s largest behavioral health organizations, has also been able to reduce suicide deaths – by 64 percent in two years, reported Becky Stoll, vice president of crisis and disaster management. But this is about more than numbers – this is about people. People like Robert, a middle-aged health care professional.

Robert was in treatment at Centerstone for bipolar disorder and suicidal thoughts when he experienced a divorce, job loss and separation from his children. As his symptoms worsened, he was periodically hospitalized, until he was placed in Centerstone’s Clinical Pathway for Suicide Prevention program. He received enhanced care, including safety planning and weekly therapy appointments, and gradually his thoughts of suicide lessened. Today, he enjoys spending time with his children and going to church. Of his care at Centerstone, Robert said, “I felt like someone cared – they were always calling me and checking in with me to see how I was doing. I am no longer isolated.”

Becky thinks of the Zero Suicide initiative as a set of bookends. At one end, you need a receptive culture and a trained and competent workforce. At the other end, you must have quality analytics and data. In between are all the things you do to work with people at risk of suicide.

“We now have evidence-based tools for identifying people at risk, doing comprehensive safety planning and using treatment modalities,” Becky said. Even something as seemingly simple as sending someone a note to say you are thinking of them has been shown to help patients stay connected to treatment.

Making Wholesale Changes

The goal, Becky said, is to weave these practices and protocols into the fabric of an organization. And like any change effort, that requires leadership at the top, commitment at all levels of the organization and a lot of time and patience. But not necessarily money – when Centerstone examined the cost of treating nearly 200 patients using the Zero Suicide approach, they found a net savings of more than $400,000 in reduced emergency room visits and hospitalizations.

Another key, David told me, is to stop thinking we can only do incremental change in health care. The goal of zero percent events and perfect care comes from the same quality playbook as that used by big companies like Toyota and Motorola or agencies like NASA, David explained. “We have to envision where we want to go instead of starting where we’re at.”

Finally, he cautioned that any successful Zero Suicide effort must include the voices of those with lived experience. For too long, we thought those who survived had nothing to tell us about those who died, “but the difference was in capability, not in personal pain,” David said. Listening to those who have lived to tell their stories fills important gaps in our understanding.

Helping People Want to Live

The time has long since passed to consider suicide a public health priority and put all our resources to bear on helping people when they need it the most. “Behavioral health should be leading this charge,” said Nelson Burns, MRC, president and CEO at Coleman. “We should be the champions.”

Zero Suicide is about changing attitudes, using data and implementing evidence-based practices. But, ultimately, Zero Suicide is about saving lives. “When you can get people to realize they want to live, that’s pretty amazing,” Becky said.

A Global Healthcare Movement

Earlier this month, over 100 leaders from 20 countries gathered in Rotterdam, Netherlands, to participate in the fourth Zero Suicide International summit. Along with Deloitte; American Foundation for Suicide Prevention; EDC, Inc.; and others, the National Council was a sponsor for this important event (Video Recap). Ian Dawe, MHSc, M.D., FRCPC, program chief and medical director, Mental Health at Trillium Health Partners, Ontario, Canada, traveled to the Netherlands to network and learn and share with others about Zero Suicide, “It’s a global movement and an emerging conversation,” he said, “but really we’re all here together to learn what each other is doing and to push it to the next level.”

Are you part of the Zero Suicide movement? If so, please share your experiences. If not, please consider getting started today. The people we serve are literally dying for our help.