ZERO SUICIDE – A commitment to suicide prevention in health and behavioral health care systems.
Zero Suicide, a project of the Suicide Prevention Resource Center (SPRC), is a key concept of the 2012 National Strategy for Suicide Prevention and a priority of the National Action Alliance for Suicide Prevention.
The foundational belief of Zero Suicide is that suicide deaths for individuals under care within health and behavioral health systems are preventable. It presents both a bold goal and an aspirational challenge.
Vermont, in its efforts to remain at the forefront of evidence-based practice, is taking on this challenge. The Vermont Department of Mental Health has chosen Zero Suicide as the framework for current state efforts in health care systems. As Vermont aligns its efforts with the National Strategy, the results and successes of this growing national initiative in communities around the country present an opportunity to have an immediate impact on the number of deaths by suicide.
7 Elements of Suicide Care for Health and
Behavioral Health Care Systems to Adopt
After researching successful approaches to suicide reduction, the Action Alliance’s Clinical Care and Intervention Task Force identified seven essential elements of suicide care for health and behavioral health care systems to adopt:
- Lead – Create a leadership-driven, safety-oriented culture committed to dramatically reducing suicide among people under care.
- Train – Develop a competent, confident, and caring workforce.
- Identify – Systematically identify and assess suicide risk among people receiving care.
- Engage – Ensure every individual has a pathway to care that is both timely and adequate to meet his or her needs. Include collaborative safety planning and restriction of lethal means.
- Treat – Use effective, evidence-based treatments that directly target suicidal thoughts and behaviors.
- Transition – Provide continuous contact and support post-discharge.
- Improve – Apply a data-driven quality improvement approach to inform system changes that will lead to improved patient outcomes and better care for those at risk.
Throughout these elements Zero Suicide emphasizes the necessity of involving survivors of suicide attempts and suicide loss in leadership and planning. As part of the state’s coordinated efforts, Zero Suicide will play a vital role for individuals under care.
The following are resources related to the Vermont Suicide Prevention Center’s implementation of the “Zero Suicide” approach throughout Vermont.
What is Zero Suicide? – Brief overview of the Zero Suicide Framework.
Zero Suicide Organizational Self-Assessment – Organizational Self-Assessment is one of the first steps. Use the results from your organization’s workforce survey when completing your organizational self assessment. The Action Alliance for Suicide Prevention offers these tools:
WGBH story- “What Happens if You Try to Prevent Every Single Suicide?”: http://wgbhnews.org/post/what-happens-if-you-try-prevent-every-single-suicide
“An effort that began in Detroit in 2001 to treat the most common cause of suicide — depression — is offering hope. With a relentless focus on finding and treating people with depression, the Henry Ford Health System has cut the suicide rate among the people in its insurance plan dramatically. The story of the health system’s success is a story of persistence, confidence, hope and a strict adherence to a very specific approach.”
Screening and Assessment Resources
These non-proprietary research-proven tools are strongly recommended in the Zero Suicide Framework for screening all patients and clients.
Patient Health Questionnaire 2 – The standard, well-known two question form that can be completed in a waiting room to determine if further conversation about depression and/or suicide needs to happen.
Patient Health Questionnaire 9 – The “next step” screen if the PHQ-2 indicates further conversation is advisable, with nine questions.
Columbia Suicide Severity Rating Scale: Lifetime – Highly-regarded evidence-based tool for suicide assessment for the first time discussing the issue with a patient/client.
Columbia Suicide Severity Rating Scale: Since Last Visit – This version of the C-SSRS takes into consideration the need for repeated screening for individuals with ongoing suicidality.
The following screening tools are also frequently used and helpful for assessing additional suicide risk factors/warning signs:
Alcohol Use Disorders Identification Test: Self-Report Version – Adapted from the World Health Organization’s Alcohol Use Disorders Identification Test.
Generalized Anxiety Disorder – 7 Item Scale – Seven question screen focusing on anxiety.
Short Michigan Alcohol Screening Test-Geriatric Version – This screen was developed because older adults may show signs of drinking problems that are different than other age ranges.
Safety Planning Resources
Safety Plan Template – Barbara Stanley, Ph.D. and Gregory K. Brown, Ph.D., developed the Safety Planning Intervention, and provide this template for clinicians.
VA Safety Plan Quick Guide for Clinicians – This safety planning quick guide was created by the Department of Veterans Affairs and offers a small brochure outlining the steps.
CALM: Counseling on Access to Lethal Means – Safety planning around lethal means is an imperative step. This two hour online webinar provides basic training in talking to clients and their families.
These articles provides an overview of Dr. David Jobes’ research-proven approach to treating suicidality.
Suicide Care in Systems Framework – Report from the Action Alliance for Suicide Prevention: Clinical Care and Intervention Task Force on the importance of systemic changes and how to replicate existing models.
The Way Forward: Pathways to Hope, Recovery and Wellness With Insights From Lived Experience – Including the lived experience of survivors and attempt survivors is essential to the Zero Suicide Framework. This report was prepared by the Suicide Attempt Survivors Task Force of the National Action Alliance for Suicide Prevention in 2014.