Grantee Types: National Strategy for Suicide Prevention

Utah will develop and implement the Utah Zero Suicide Project in order to strive towards the aspirational goal of suicide as a never event for people in care. The purpose of the project is to reduce non-fatal suicide attempts and suicide deaths for adults 25+ in Utah. We propose to do this through the following goals:

· Increase access to and quality of physical and behavioral health care for those at risk for suicide
· Improve rapid follow up and care transition services for individuals at risk for suicide statewide
· Reduce access to lethal means among those identified at risk for suicide.

The Utah Division of Substance Abuse and Mental Health (DSAMH) is committed to the adoption of the ‘Zero Suicide’ approach to behavioral health care and promotion of the approach within all health and behavioral health care settings statewide. The provision of follow-up and care coordination services for individuals discharged from emergency departments and inpatient hospital settings following a suicidal crisis will be piloted by two Local Mental Health Authorities (LMHAs), in an urban and rural community. This project will result in the improved ability of physical health providers, behavioral health providers, first responders, and other community and clinical service providers to respond to individuals at risk for suicide through assessment, intervention, and effective clinical care through a series of training initiatives. Annual Zero Suicide Leadership Summit, clinical training on safety planning/crisis response planning, screening and assessment of suicide risk training using the Columbia Suicide Severity Rating Scale, Counseling on Access to Lethal Means and other lethal means restriction activities, Brief-Cognitive Behavioral Therapy for Suicide Prevention clinician training, Collaborative Assessment and Management of Suicidality clinician training, develop and distribute model follow-up and care transition protocols that outline best practices for ensuring patient safety for individuals at risk for suicide and best practices for communicating and referring between medical providers and behavioral health organizations; develop online enduring Continuing Medical Education training on best practices for follow-up and care transitions based on model protocols; and develop and train on suicide prevention/intervention training for Certified Peer Support Specialists. Utah has a demonstrated need to improve the skills, training, and support of the workforce to effectively respond to someone at risk for suicide and these initiatives will result in that improvement. The Utah Zero Suicide Project will result in a coordinated, sustained effort to help our state substantially reduce the suicide rates for those in care.

The Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) proposes Tennessee TARGET Zero Suicide (TARGET) to reduce suicide attempts/deaths among working-age adults ages 25-64 by developing and implementing cross-system suicide prevention strategies, including rapid and enhanced follow-up for 2,250 unduplicated adults (Yr 1: 1,000; Yrs 2-3: 1,250/yr) and prevention training for 570 providers and stakeholders.

TDMHSAS will develop partnerships with emergency departments and inpatient psychiatric units to refer at-risk adults to TARGET for follow-up care following discharge for a non-fatal suicide attempt or suicide crisis. Centerstone of Tennessee will provide telephone and/or face-to-face follow-up within 24 hours, weekly for the first month, and at 3/6/9/12 months. Follow-up will include risk assessment, development of a crisis management plan with the participant, means reduction counseling, and referrals/linkages to treatment services utilizing best practices Applied Suicide Intervention Skills Training (ASIST), Counseling on Access to Lethal Means, and evidence-based Columbia Suicide Severity Rating Scale (C-SSRS). The Tennessee Suicide Prevention Network will provide suicide prevention trainings for clinical providers (e.g., primary, behavioral, emergency, VA) and adult-serving systems (e.g., corrections, workforce development, human services, military). TARGET will also work to implement a Zero Suicides framework across state departments and health, behavioral health, workplace, military, justice, etc., settings. Outcomes will include reduction in suicide attempts by 30% and suicide deaths by 10%. An existing Advisory Council, comprising suicide attempt/loss survivors and other stakeholders, will support TARGET’s goals/objectives: (1) improve care transition/ coordination of at-risk adults post discharge, (2) increase the number of providers and stakeholders trained in adult suicide prevention, assessment, and treatment, (3) increase risk identification, referral, and behavioral health services utilization, and (4) implement Goals 8 and 9 of the 2012 National Suicide Prevention Strategy. Evaluation will be conducted by staff experienced in suicide prevention, and all required reports on outcomes and infrastructure development will be met.

This project will further enhance and refine the state’s suicide prevention care pathway in behavioral health, primary care, and hospital emergency service settings. Project goals are to: (1) Increase suicide prevention and treatment capacity and implementation within behavioral health settings; (2) Increase suicide prevention and treatment capacity and implementation within hospital settings statewide; (3) Increase the number of adults at risk of suicide who are identified and receive suicide prevention competent mental health services; (4) Increase the number of effective and evidence-based clinical suicide prevention, identification and treatment practices implemented; and, (5) Improve and expanded suicide surveillance systems.

This proposed project will extend prevention and treatment services to all 77 counties through the state’s 14 community mental health centers (CMHCs), and to 6,000 practicing primary care physicians and 83 emergency rooms. The CMHCs will train clinicians in Collaborative Assessment and Management of Suicidality (CAMS), Applied Suicide Intervention Skills Training (ASIST) and Question, Persuade, Refer (QPR), and will enhance Electronic Health Record systems to include a suicide prevention care pathway. All CMHCs will implement the AVERT Suicide Risk Assessment Program to screen and assess all patients in ODMHSAS care. Contracted hospitals will provide clinical training for physicians, gatekeeper training for staff, and establish an emergency department suicide attempt database with follow up consent protocol. The project will reach nearly 1,762 individuals with suicide prevention training/education, 60,000 clients with suicide prevention screening and treatment when indicated. The project is expected to reduce the rate of non-fatal suicide attempts and deaths in adults ages 25-64.

This initiative is developing a Zero Suicide culture. The goals of this initiative are to: (1) promote suicide prevention as a core component of health care; (2) implement effective practices for assessing and treating those at risk for suicide; (3) ensure meaningful collaboration with people who have lived experience of suicide; and (4) implement strategies to address behavioral health disparities for those with limited access to care (e.g., people in rural and frontier areas, culturally diverse populations, and veterans). This initiative works at the local level to pilot the model and at the state level to impact policy and sustain and spread the model statewide.

The Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) proposes Tennessee TARGET Zero Suicide 2 (TARGET2) to reduce suicide attempts/deaths among adults ages 25 and older by expanding and enhancing suicide prevention strategies, including rapid and enhanced follow-up for 2,750 unduplicated target region adults (Yr 1: 750; Yrs 2-3: 1,000/yr) and prevention training for 300 statewide providers and stakeholders. The statewide focus population ages 25 and older is primarily white (78%), with 15% African American and 2% Hispanic/Latino. Over 13% live below poverty, 14% lack health insurance, 15% lack a high school diploma, and over 7% are unemployed. Focus population clinical characteristics (e.g., SMI, SUD, COD) are risk factors for suicide attempt/death. The focus population’s suicide rate (20.9) exceeds the U.S. rate (18), and has consistently exceeded the national rate for 15+ years. Baseline data for Tennessee reveals that 937 adults ages 25 and older died by suicide, and 6,275 were discharged (inpatient, outpatient) after non-fatal suicide attempts in 2015. The adult (25+) suicide rate among Tennessee’s minority groups other than African Americans is 11.6 versus an 8.8 national rate, and Veterans comprise 17% of state suicides.

TDMHSAS will implement the following strategies/interventions throughout TARGET2 in collaboration with project partners: Centerstone of Tennessee will provide rapid enrollment and follow-up prior to/within 24 hours of discharge and weekly for one month. Follow-up will include risk assessment, crisis management plan development, means reduction counseling, and referrals/linkages to treatment services utilizing best practices Applied Suicide Intervention Skills Training, Counseling on Access to Lethal Means, and evidence-based Columbia Suicide Severity Rating Scale. TARGET2 participants will be assessed and treated according to Centerstone’s Clinical Pathway for Suicide Prevention, and Centerstone will pilot and evaluate a suicide-specific clinical treatment for those on the Pathway. The Tennessee Suicide Prevention Network will provide suicide prevention trainings for clinical providers and adult-serving systems, and will assist in establishing/implementing a Gatekeeper Surveillance Network and Call Line for training participants. TARGET2 will expand the Zero Suicide framework statewide, and an existing Advisory Council, comprising suicide attempt/loss survivors, will support TARGET2’s goals, including:

(1) enhance/expand rapid follow up for adults post discharge,
(2) increase follow up and care transition/coordination for high risk adults,
(3) train community and clinical service providers and systems,
(4) collaborate with relevant sectors and with state departments/ systems to implement comprehensive suicide prevention, and
(5) implement Goals 8 and 9 of the 2012 National Suicide Prevention Strategy.

Measurable objectives include reductions in suicide attempts by 35%, suicide deaths by 20%, and service/utilization costs related to suicide by 30%. TARGET2 includes a comprehensive evaluation to develop and disseminate a thoroughly documented service model for replication and adoption.