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Zero Suicide in Health Care

Increased deaths from suicide are in the news. The suicide rate has risen almost 30% since 1999, and the Centers for Disease Control recently reported that the increased suicide rate contributed to a rare rise in the overall death rate for Americans in 2015. What can be done to stem this tide? In particular, what can be done in behavioral health programs, where the people most at risk for death by suicide receive care?

One would think that detecting and caring for suicidal patients was not new. Unfortunately, this isn’t true. Health and even mental health providers have not been tuned in to suicide care. In multiple studies, up to 45% of all patients, and a shocking 78% of older people who die by suicide, saw a medical doctor in the month before they died. Studies in multiple states find that up to 25% of all suicide victims had received community behavioral health care, when only about 2% of the population received community care. Something was missing.

One surprising gap is the poor training of most mental health professionals such as therapists, psychologists and even psychiatrists in treating suicidal patients. Good training in caring for these patients should be expected, since suicidal patients are usually sent for care to mental health settings. However, these skills are rarely provided in the graduate training of licensed mental health professionals. A few states, such as Washington and Kentucky, have recognized this gap and passed laws to require continuing education in suicide care. But community providers increasingly recognize that pre-service clinical training is inadequate.

Providing Effective Suicide Care With the Zero

Suicide Approach

Better training is necessary, but providing good suicide care takes work. The good news is that effective screening tools and treatments now exist. The bad news is that since these tools are new, they are not used yet in most health and behavioral health care settings. We have evidence that systematic suicide care can be effective. At the Henry Ford Health System in Detroit, the “Perfect Depression Care” effort—a systematic quality improvement program in the behavioral health division—reduced suicide deaths among people receiving care by over 75%.

The new tools for suicide care have been bundled together in an approach we call “Zero Suicide in Health Care,” and implemented successfully in real world clinics and health systems. The resources behind the approach are described in detail at www.zerosuicide.com. A leading example of providing suicide safe care is the nation’s largest community behavioral health provider—Centerstone. They have demonstrated that excellent suicide care is feasible.

Over 200 health care organizations in the United States, with others in the Netherlands and United Kingdom, are now putting the Zero Suicide approach in place. But most health care today cannot be labelled “suicide safe,” and taking on the mission of suicide prevention is a new challenge for health care organizations. The Joint Commission, the leading accreditor of hospitals, has issued a “Sentinel Event Alert” that puts health care organizations on notice that detecting suicidality among patients and working to keep them safe should be expected. We hope that these developments, and new leadership among health care professionals to prevent suicide, can make a difference. Suicide is preventable—if we work at it.

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