Zero Suicide: Transitions in Care

This week is National Suicide Prevention Week and it is important to highlight the efforts taking place between multidisciplinary partners in Vermont to address suicide prevention across the continuum of care– from prevention to recovery. In 2015 the American Association of Suicidology reported that every 11.9 minutes a United States citizen died by suicide – a total of 44,193 individuals. Nationally, deaths by suicide have been on the rise for the last few years. In Vermont, on average 2 or more people die by suicide every week. It is vital that private and public community organizations continue working together to initiate a decrease in these statistics.


Zero Suicide, a key concept of the National Strategy for Suicide Prevention, 2012, is a coordinated systems approach to suicide prevention, with the belief that suicide deaths for individuals under care within health and mental health systems are preventable. Zero Suicide starts with leadership commitment to examine suicide prevention and treatment across the organization. Zero Suicide is in various phases of implementation across the country, including Vermont pilot communities in Chittenden, Franklin, Grand Isle and Lamoille Counties. One of the essential elements of the Zero Suicide Framework is continuous contact and supportive transitions between care.


Care transitions are a time of high risk for patients who have made a suicide attempt during which they transition from inpatient, primary care, or the Emergency Department to mental health care. Luxton, et al., in 2012, found that “the risk of suicide attempts and death is highest within the first 30 days after a person is discharged from an inpatient psychiatric hospital”, and that 70% of patients who have attempted suicide don’t show up at their first outpatient appointment. A 2000 study by Boyer, et al. found that effective clinical bridging strategies used by health care organizations can triple the likelihood that a patient will receive outpatient care.


The American Association of Suicidology revealed that there are a number of barriers to smooth care transitions, including the fact that there has been no widely used standard practice to integrate and coordinate suicide prevention efforts. In Vermont, suicide death rates have averaged 30% higher than those of the general U.S. population since 2005. According to the CDC, with 61.1% of Vermont’s population being rural this makes it challenging to deliver and sustain suicide-safe, coordinated care to those who need it: residents are less able to access services and educational information about suicide.


In Vermont, mental health designated agencies are working in Chittenden, Lamoille, Franklin and Grand Isle Counties to create better care linkages with hospital emergency departments, primary care and inpatient hospitals through the Zero Suicide Pilot project. For example, Northwestern Counseling and Support Services provides Mental Health First Aide trainings to community healthcare providers and is implementing a suicide screening project in the ER with the Vermont Department of Mental Health and Northwestern Medical Center.


New Hampshire is also working to overcome barriers to smooth care transitions by creating the New Hampshire Nexus project. The New Hampshire Nexus Project is a collaboration of New Hampshire Hospital, NAMI New Hampshire, Regional Public Health Networks, Community Mental Health Centers, and Peer Support Services, working together to create a continuous care experience for high-risk youth after discharge from New Hampshire Hospital. Composed of education to youth, identifying social supports, partnering with agencies, safety planning, and ongoing assessment, the project follows individuals and families for up to 90 days post inpatient hospital discharge. Care coordination and contacts, both face-to-face and over the phone, using open communication facilitate a smooth process for participants. Service providers measured preparedness using a) Hope, b) Connections/Support, and c) Self-Management, while assessing suicide risk to determine patient progress.


For more information about suicide prevention in Vermont visit:


If you are feeling suicidal, or are concerned about someone else, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), visit to text/chat, or contact the Vermont Crisis Text Line by texting VT to 741741.


You can support the work of the VT Suicide Prevention Center by participating in their Global Giving Accelerator crowdfunding campaign! Between September 11th and September 29th, CHL will raise $7,500 from 40 unique donors! Visit the and contribute today!

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