Zero Suicide: Aspirational or Reality?

Zero SuicideIt turns out that almost everything I was taught about suicide during my clinical training is not true. Contrary to what most clinicians are taught, there is clinical protocol we can follow to prevent suicide attempts – apart from locking people up.

Very little of this new knowledge about detecting and treating suicidality has translated into practice, partly due to the entrenched stigma that still surrounds talking about suicide. Yet each year, nearly three times as many Americans die from suicide as from homicide. More Americans kill themselves than die from breast cancer. Strikingly, almost half of all of those who die from suicide had contact with their primary care physician in the preceding month. Among older adults, it’s 78 percent. Consequently, screening questions about depression and suicidality in primary care matter. Lastly, 19 percent of people who die from suicide had contact with mental health services in the month before.

Recently published Centers for Disease Control and Prevention figures reveal that US suicide rates are at a 30-year high – in spite of suicide prevention programs in every state, with screening, hotlines and efforts to raise educational awareness.

The long and short of it is that suicide is a problem that can no longer be ignored. Recently published Centers for Disease Control and Prevention figures reveal that US suicide rates are at a 30-year high – in spite of suicide prevention programs in every state, with screening, hotlines and efforts to raise educational awareness. What we’re doing just isn’t working.

What the evidence reveals

Therefore, we need to look to the evidence to determine what works for suicide prevention. That evidence base leads to the following four approaches to treatment:

  • Non-demand caring contacts are straightforward follow-ups with people following discharge from inpatient care. These contacts can be via letter, phone call, text or in person. What matters is some kind of contact in the immediate high-risk period following an inpatient admission.
  • Cognitive behavioral therapy for suicide prevention (CBT-SP) is a specific type of CBT that includes cognitive-restructuring strategies, emotion-regulation strategies, behavior activation and problem-solving to reduce suicide attempts and symptoms. For adolescents, this approach also includes family interventions, if needed.
  • Several randomized controlled trials have demonstrated the effectiveness of dialectical behavior therapy (DBT) at reducing suicidal behavior and other behavioral health issues. Pioneered by Dr. Marsha Linehan, DBT addresses an individual’s readiness for acceptance and change. It includes weekly group and individual treatment.
  • Also demonstrated by several trials, including one randomized feasibility trial, the collaborative assessment and management of suicidality (CAMS) is a framework that engages patients in owning and developing their own treatment plan in an outpatient setting.

Developed over the last 15 years, these new evidence-based practices, together with cultural change and improved tracking, redefine our approach to treating suicidality. Collectively, these activities define a new movement referred to as Zero Suicide. Experience from the Henry Ford Health System, and elsewhere, demonstrates this audacious goal can become reality – not just aspiration.

In Massachusetts, like other states, we have numerous collaborations and organizations already working hard to reduce the number of suicides. One example of where Beacon Health Options, through its Massachusetts Behavioral Health Partnership, is seeking to implement the principles of Zero Suicide is our participation in the Massachusetts Youth Suicide Prevention Project. This coalition of youth-serving state agencies and rural health care systems aims to reduce the number of suicide attempts and deaths among youths ages 10-24 through school-based education programs, engagement of community leaders, awareness trainings for youth-engaged professionals (e.g., teachers and clergy), and more.

Developed over the last 15 years, these new evidence-based practices, together with cultural change and improved tracking, redefine our approach to treating suicidality.

In summary, many of us know someone who has attempted or completed suicide. It happens. But there is more we can do to prevent it. That work is not about the heroics of individual clinicians; it’s about the implementation of a systematic clinical approach. And executing against a big, hairy, audacious goal: Zero Suicide.

Additional reference:

Beacon supports the National Action Alliance on Suicide Prevention and the Workplace Task Force dedicated to addressing the role employers can play in reducing suicide by increasing help-seeking behaviors and creating a healthy workplace culture: http://actionallianceforsuicideprevention.org/task-force/workplace

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3 Comments. Leave new

Dave West, LCSW
May 10, 2016 8:34 pm

Zero Suicide is indeed an audacious goal. The list of four points of what evidence reveals seems to the same approaches that the field has been using over the past 20 years. The current high rate of incidence would seem to indicate a greater need to understand the systematic causes in order to design a holistic systematic intervention – beyond just psychotherapy. A social work model would broaden the perspective to include more dynamics related to cultural, economic, religious, social values, etc. It is indeed an uphill challenge to appropriately impact suicide. But organization that take an ongoing holistic approach are heroes to the mental health of the community.

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Sabrina Warburton
May 11, 2016 6:11 pm

I recently learned about a case of a mother, who had no history of depression or suicidal attempts, losing her life at the first attempt. How do we address similar cases? This person wasn’t on anybody’s radar.

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Betty Nadeau
May 12, 2016 9:21 am

After losing two family members to suicide, I have learned that all primary care doctors must screen for depression and suicidal ideation at every visit and refer if determined to be at risk. Mental health professionals must assess with the evidence-based Columbia Suicide Severity Rating Scale at every visit. Clinicians must ask the tough questions and invariably the patient will be relieved to find that someone really cares. A Safety plan prepared by the patient and clinician is critical as well inquiring about means and restricting access to means i., e. guns, drugs, etc. Collaborative evidence-based care and pulling family members and loved ones into the care team is essential. Let me assure you that my brother never would have left his wife for one minute, if he had known that she would hang herself. Why Zero Suicide? Because it works! Let’s not settle for less!

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