Zero Suicide

For the past four years, SPRC has served as the Executive Secretariat for the Action Alliance for Suicide Prevention. The Alliance and its task forces have accomplished a great deal of important work during this period. Today, I would like to use this opportunity to focus on one of the Action Alliance’s priorities: Transform health care systems to significantly reduce suicide. In particular, I would like to focus on the audacious goal of zero suicides in health and behavioral health care settings. The “Zero Suicide” concept—like many of our best efforts—grows from the U.S. Air Force suicide prevention work in the 1990’s but is based more specifically on work done in several health care organizations, particularly the Henry Ford Health System (HFHS) in Michigan.

The Henry Ford Health System has achieved some significant improvements in safety and health outcomes by applying a quality improvement process to problems such as inpatient falls and medication errors. Just as the health care field is now learning from the safety lessons of other industries (like commercial aviation) that have implemented quality improvement processes, HFHS realized that mental health care could be improved using a similar approach.

This led to the concept of the “perfect depression care” system, which includes suicide prevention as an explicit goal. This effort led to an 80% reduction in the suicide rate among their health plan members.

The Action Alliance Clinical Care and Intervention Task Force examined the work of the Henry Ford Health System and reviewed improvements in suicide care that have emerged in the past 15 years. The task force identified six dimensions that appear to be essential for a health care system to transform itself to create a Zero Suicide culture. These dimensions include:

1. Creating a leadership-driven safety-oriented culture that commits to dramatically reducing suicide among people under care
2. Systematically identifying and assessing suicide risk level
3. Ensuring every person has a pathway to care – a pathway that involves every component of the health system
4. Developing a competent workforce
5. Using effective, evidence-based care, including collaborative safety planning
6. Continuing contact after care

The nation is currently engaged in a conversation about—and a transformation of—its health care system. This is the time to ensure that suicide prevention is part of this conversation and included in this transformation. We need to look at every component of the health care delivery system to assess which changes could contribute to preventing suicide, and we need to make sure that those changes are made. We need to expand the concept of Zero Suicide beyond boundaried healthcare systems like HFHS to every delivery environment in which people receive care. The journey to making suicide a “never event” might be a long one – but it is a journey we must take. Our goal of Zero Suicide is aspirational, but it is a goal we should strive to reach each and every day.

The National Action Alliance for Suicide Prevention has created a Zero Suicide in Health and Behavioral Health Care website and toolkit. I urge you to become familiar with the concept and components of the Zero Suicide approach, apply them to your work, and help us educate our colleagues and collaborators about Zero Suicide and the practices that will help us achieve this goal. Those we serve deserve nothing less.