Suicide in the United States has become an increasing public health problem over the past few decades. From 2000 to 2016, the suicide rate increased 30% from 10.4 per 100,000 to 13.51. In 2016 suicide was the tenth leading cause of death for people in the United States2. Additionally, it is the second leading cause of death for 15-29-year olds2. Nevada is one of the worst states for suicide. In 2016 suicide was the 7th leading cause of death in Nevada3. Suicide not only continues to affect Nevada and the United States, but it is also a worldwide epidemic affecting nearly 800,000 people every year4.
Historically, suicide has been viewed as an unfortunate negative outcome of some other mental health concern. In the US, the National Action Alliance for Suicide Prevention along with the Substance Abuse and Mental Health Services Administration (SAMHSA) has put forth the Zero Suicide (ZS) Model, a framework to coordinate a multilevel approach to implementing evidence-based practices. The foundation of this initiative is that suicide deaths for individuals under care within health and behavioral health systems are preventable6. According to the ZS Initiative there are seven pillars that are needed to reduce suicidal deaths across a system. These are: leadership, training, identification and assessment, engagement, treatment, transition/continuity of care, and improvement7.
Elements of Zero Suicide
- Lead system-wide culture change committed to reducing suicides
- Train a competent, confident, and caring workforce
- Identify patients with suicide risk via comprehensive screenings
- Engage all individuals at-risk of suicide using a suicide care management plan
- Treat suicidal thoughts and behaviors using evidence-based treatments
- Transition individuals through care with warn hand-offs and support contacts
- Improve policies and procedures through continuous quality improvement
These steps were designed to be easily incorporated into standard clinical and behavioral health practices to increase safety and teach coping strategies and to improve ongoing contact and monitoring of high-risk individuals during transitions in care and other high-risk periods8.
The ZS is a commitment to suicide prevention in health and behavioral health care systems. After being discharged from the hospital patients with a severe mental illness can have a higher risk of suicide. According to SAMHSA these risks can be mitigated through9:
- Coordination between inpatient and outpatient services
- Safety planning prior to inpatient discharge
- Immediate involvement of family, friends, and social support
- Maintaining continuity of care best practices n Follow-up with the patient within 24 hours after discharge
It is also necessary to ensure continuity of care after an intent-to-harm-self emergency department visit. Types of care include9:
- Schedule follow-up appointment prior to discharge
- Follow-up appointments ideally occur within 24 to 72 hours post-discharge. When possible, facilitate contact between the patient and the follow-up facility prior to discharge.
- Provide crisis and contact information
- Develop a personalized safety plan
- Review discharge recommendations with the person and approved social support
The ZS model includes training health professionals in prevention. More than 30 percent of people who die by suicide are receiving mental health care at the time of their deaths, and 25 percent visit an emergency department within a month of dying10. The Henry Ford Health System helped develop the ZS model and achieved an 80 percent reduction in suicide among patients treated for a mental health or substance use disorder11. The use of the ZS model has proven to help reduce suicides if it is implemented in a systematic manner. Basically, responsibility for deaths caused by suicide is placed on the healthcare system instead of individuals.
Providers that want to implement the ZS system can visit Zero Suicide. This site has many resources including a getting started toolkit, information and events, along with resources and studies. Implementing this model can be difficult because it requires a system-wide approach, but it has proven to help reduce the risk of suicide. Broader adoption of improved suicide prevention care may be an effective strategy for reducing deaths by suicide.
Imagine a World Where…
We can talk about suicide openly, honestly, empathically and directly.
- Not one patient in healthcare dies by suicide
- Leaders, administrators, professionals, patients, families, and communities line up around the central goal of suicide prevention in high quality mental health and addiction care
- Augmentation of hope, safety, recovery and perspective is core to all interventions within healthcare systems
- And, as a consequence, population suicide rates drop dramatically
- Hedegaard H, Curtin S, Warner M. Suicide Rates in the United States Continue to Increase. Hyattsville, MD: National Center for Health Statistics; 2018.
- Heron, M. (2018). Deaths: Leading Causes for 2016. National Vital Statistics Reports,67(6). Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_06.pdf.
- State Fact Sheets. (2016). Retrieved from https://afsp.org/about-suicide/state-fact-sheets/#Nevada
- World Health Organization. (2018, August 28). Suicide data. Retrieved from http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/
- de Jonge, V., Nicolaas, J., van Leerdam, M. & Kuipers, E. (2011). Overview of the quality assurance movement in healthcare. Clinical Gastroenterology, 25(3), 337-347.
- What is Zero Suicide? (2018). Retrieved from https://zerosuicide.sprc.org/about
- Education Development Center. (2015). Zero Suicide in health and behavioral healthcare.Retrieved from zerosuicide.com
- Brodsky, B. S., Spruch-Feiner, A., & Stanley, B. (2018). The Zero Suicide Model: Applying Evidence-Based Suicide Prevention Practices to Clinical Care. Frontiers in Psychiatry,9. doi:10.3389/fpsyt.2018.00033
- Substance Abuse and Mental Health Services Administration. (2018). Suicide Prevention Facts and Resources. Retrieved from https://www.samhsa.gov/sites/default/files/sites/default/files/suicide_prevention_facts_and_resources_fact_sheet.pdf
- “Colorado ‘zero suicide’ bill heads to the governor’s desk.” Mental Health Weekly, 9 May 2016, p. 8. Health Reference Center Academic, http://link.galegroup.com/apps/doc/A454609350/HRCA?u=reno&sid=HRCA&xid=f8c4d227.
- Coffey, M., Coffey, E. (2016). How we Dramatically Reduced Suicide. NEJM Catalyst. Retrieved from: https://catalyst.nejm.org/dramatically-reduced-suicide/