Zero Suicide: A Model to Live By

Suicide is a leading cause of death in the United States: According to the Centers for Disease Control and Prevention (CDC), suicide is the 10th leading cause of death in the United States, with a rate of 14.0 suicides per 100,000 people in 2020.

Suicide rates have been increasing in recent years: The CDC reports that suicide rates in the United States have been increasing since 1999, with the highest rate recorded in 2020.

Access to mental health services is a key factor in preventing suicide: Studies have shown that access to mental health services can play a critical role in preventing suicide. However, only about half of individuals in the United States with a mental illness receive treatment, which can lead to a higher risk of suicide. Improving access to mental health services, especially for those at high risk of suicide, is a key factor in reducing the rate of suicide.

This past year, I have had the opportunity to receive extensive training in the Zero Suicide Model, as well as join a Zero Suicide Collaborative! Yes, these exist!

The Zero Suicide Model is a comprehensive approach to suicide prevention in healthcare organizations. It is based on the idea that suicide deaths for individuals under the care of health systems are preventable, and it aims to reduce the number of suicide deaths through a combination of clinical, organizational, and cultural changes. The Zero Suicide Institute is a non-profit organization that provides training, resources, and technical assistance to healthcare organizations to implement the Zero Suicide Model.

This Model is an evidence-based approach that has been shown to reduce suicide deaths in health systems. It consists of seven key components: leadership commitment, clinical best practices, a suicide care management team, data-driven quality improvement, suicide risk assessment, and safety planning, employee training and cultural competence, and ongoing evaluation and improvement.

Leadership commitment is essential to the success of the Zero Suicide Model. The organization's leadership must make a public commitment to the prevention of suicide deaths and create an infrastructure to support the implementation of the model. This includes ensuring that the resources and support are in place for the staff to implement the model effectively.

Clinical best practices are an important component of the Zero Suicide Model. This includes evidence-based assessments, risk stratification, and evidence-based treatments for those at risk of suicide. It is essential for healthcare organizations to provide their staff with the training and resources they need to effectively assess and treat individuals at risk of suicide.

The Zero Suicide Model also includes a suicide care management team, which is responsible for ensuring that all patients at risk of suicide receive appropriate care. This team should include individuals from various departments, such as psychiatry, nursing, social work, and primary care. The team should also have the resources and support they need to effectively coordinate care for patients at risk of suicide.

Data-driven quality improvement is a crucial component of the Zero Suicide Model. This involves regularly collecting and analyzing data to monitor the effectiveness of the model and identify areas for improvement. The data should be used to inform clinical decision-making and guide the development of new best practices for suicide prevention.

Suicide risk assessment and safety planning are critical components of the Zero Suicide Model. All patients at risk of suicide should receive a comprehensive assessment to determine their level of risk and develop a safety plan to reduce that risk. This safety plan should include information on warning signs, coping strategies, and the steps to take in the event of a crisis.

Employee training and cultural competence are also important components of the Zero Suicide Model. All staff, including those who may not work directly with patients, should receive training on suicide prevention and risk assessment. This training should help staff understand the warning signs of suicide, how to respond to a crisis, and how to provide appropriate referrals for those at risk of suicide.

Finally, ongoing evaluation and improvement are essential to the success of the Zero Suicide Model. Regular evaluations should be conducted to monitor the effectiveness of the model and identify areas for improvement. This feedback should be used to make ongoing improvements to the model, to ensure that it remains effective in reducing the number of suicide deaths.

Consider these action steps in confronting suicide prevention in your agency or practice:

1) Integrative in-depth charting that showcases the golden thread regarding suicide prevention. A data-driven system that showcases comparative charts. How many clients indicated having suicidal hx, or suicidal ideation? Of these, how many received a safety plan? Of those, how many clients indicated utilizing said safety plan? Collectively, how many were assessed within sessions at each session for suicidality? This data-driven approach will help bring to light any gaps that may exist systematically.

2) Consider surveying your agency annually and upon hire. How many of your workforce know how to respond if another staff, a stakeholder, or a client presents signs of suicidality? For a long time, suicidality has been seen as a personal concept not to be discussed. This Model suggests the opposite. Suicide is a community disruptor, and thus it is everyone’s responsibility. You may be surprised at your findings. Connecting training completion numbers will also give you a sense of security knowing your agency is on the same page regarding suicide prevention.

3) Incident Reporting monitoring for charting EMS and Hospitalizations. Indicating how many are related directly to suicidality.

4) Collaboration with staff/ teams in developing effective/evidence-based responses to suicidality. These are to be constructed as action steps within the incident reports themselves. Mitigation both from a formal lens, and a 1x1 approach.

5) Incorporating accessibility to mental health services (even if they are not through you or your agency) after hours 24/7. Accessible care does not always mean it must be territorial care- you can not be all things to all people all of the time. Consider a variety of tools/ hotlines/ apps/ community centers/ private practices as means to equip the client.

In the most recent Zero Suicide Collaborative meeting, we discussed IFS- internal family systems, as well as the development/ implementation of Peer-Led Suicide Prevention groups. Derek Vaughn from the Gibson center in Cape Girardeau Missouri reflected on their groups called the 988 group.

We viewed resources like the following:?

https://drexel.edu/familyintervention/abft-training-program/abft-training/Self%20Paced%20Course/

https://didihirsch.org/download-best-practices-manuals-toolkits/

We even had a rep from the Missouri Department of Mental Health (DMH)/ Casey Muckler, showcase a new magazine type resources rolling out to schools! See below

https://www.flipsnack.com/pathtomysuccessprograms/988_guide-for-schools/full-view.html

In conclusion, the Zero Suicide Model is a comprehensive approach to suicide prevention that has been shown to be effective in reducing the number of suicide deaths in health systems. The Zero Suicide Institute provides training, resources, and technical assistance to healthcare organizations to implement the model effectively. By implementing the Zero Suicide Model, healthcare organizations can play a critical role in preventing suicide deaths and improving the lives of individuals at risk of suicide.

Geries Shaheen is a Licensed Professional Counselor and Nationally Certified Counselor operating in and around St. Louis Missouri. Geries holds his MA in Professional Counseling from Lindenwood University, BA in Intercultural Studies from Lincoln Christian University, and holds a certificate in Life Coaching, Geries provides life coaching services to clients online globally. Geries is EMDR trained and DBT Certified, practicing from a TIC lens.