zero suicide: how do we make a long term difference?

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Zero Suicide: How do we make a long-term difference? DAVID W. COVINGTON, LPC, MBACEO & PRESIDENT, RI INTERNATIONALPUBLIC HEALTH ENGLAND ZERO SUICIDE FORUM FEBRUARY 2016

2Big Hairy Audacious Goals (BHAGs)

Smallpox was eradicated in 1980. The five-year survival rates in 1975

of certain forms of cancer, such as breast, prostate, and colorectal, were 75%, 69%, and 51%, respectively. In 2007, survival rates increased to 90%, 100%, and 67%, respectively.

And the incidence of polio has gone down dramatically since 1988, when over 350,000 cases were reported. In 2014, that number plummeted to only 359 reported cases, a 99% decrease.

6380      Computer/web services

4Target Zero and Performance Improvement

5Major Reductions

ZS Initiative Impact StatusUS Air Force One-third reduction

over six years1996 - 2002

Henry Ford Health System

75% reduction in first four years

2001 - Present

Magellan Health in Arizona

38% reduction in first two years

2009 - 2013

Centerstone 65% reduction in first two years

2013 - 2016

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1996

“[At the start] there was a lot of debate about whether or not it was even possible to reduce suicide through this type of an effort,” according to David Litts. “A lot of people, including mental health practitioners, were skeptical. But over a six-year period, the suicide rate dropped by one-third.”

US Air Force Initiative7

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1996

Prominent suicidologists, argued successfully, albeit erroneously, that this is not a healthcare issue. They kept suicide out of the mental health Bible, the DSM, stating, “suicide is, by definition, not a disease, but a death that is caused by a self-inflicted intentional action or behavior.”

Not a Healthcare Issue?

2001

9Crossing the Quality Chasm

After becoming a finalist for a Robert Wood Johnson Foundation grant, Don Berwick challenged the HFHS team to pursue perfection. A nurse staff member suggested that would mean zero suicide deaths. Within four years, their death rate had decreased by 75 percent.

2005

Prior to 2000, there was little research on crisis call center effectiveness, and credibility was low. Since 2005, Link2Health has dramatically increased calls and capacity, started a Veteran’s hotline, added chat technology, and introduced best practice standards now utilized worldwide.

10Standards, Training and Practices

2009

11Reducing Both Death Rates and Cost of Care

Arizona DHS and Magellan Health challenged the provider network to eliminate health plan suicides. In 2011, Behavioral Healthcare cited a 38% reduction in deaths, decreased hospitalizations and dramatic increases in staff confidence.

12The National Action Alliance for Suicide Prevention

In 2012, the US Surgeon General and the National Action Alliance published a revised national strategy with new goals 8 and 9, calling for suicide prevention to become a “core component” of health care, and for improved professional and clinical practices, respectively.

2010

2011

In 2011, a task force of the National Action Alliance set out to identify the best practice toolkit of interventions for clinical care staff. The group was captivated by the cultural and system changes of the pioneers below, and designed and published a framework for replication.

13A Systems Framework

2012

Between 1997 and 2006, mental health services implemented recommendations to improve crisis and suicide care. While et al concluded that implementing these recommendations was associated with lower suicide rates in both cross-sectional and before-and-after analyses. The provision of 24 hour crisis care was associated with the biggest fall in suicide rates

14While et al Study Evaluation Nine Recommendations

2014

The Substance Abuse and Mental Health Service Administration (SAMHSA) funds the first cohort of 16 organizations and 48 leaders to develop implementation plans. Faculty include champions from IFH, Centerstone America and Group Health. The SPRC organizes and hosts the event.

15Implementation Academies

The Suicide Prevention Resource Center develops a fidelity toolkit and website to guide implementation, with seven key domains:

16Fidelity Toolkit

2016

RFA-MH-16-800: Applied Research Toward Zero Suicide Healthcare Systems (R01) - Applied research that advances the Action Alliance's “Zero Suicide” goal for individuals receiving treatment within health care systems, needed to implement effective and comprehensive strategies in a variety of settings, including behavioral health and substance abuse outpatient clinics, Eds and crisis care programs and centers, hospitals, and integrated primary care programs

17NIMH Research Grant

2014

Leaders from New Zealand, the UK, the US and the Netherlands met at IIMHL in Oxford, UK. Dutch psychiatrist Jan Mokkenstorm: “We are at the beginning of this journey and start out from the core value that not one of our patients should die alone and in despair.”

181st International Summit (Oxford 2014)

2015

In September, a group of 50 service users from 13 countries, healthcare providers and government policy makers convened in Georgia. The International Initiative for Mental Health Leadership match created an international consensus document and plan for expanding the social movement.

192nd International Summit (Atlanta 2015)

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2017

In September, a group of 40 service users from 13 countries, healthcare providers and government policy makers will gather in Georgia. The International Initiative for Mental Health Leadership match will create an international consensus document and plan for expanding the social movement.

213rd International Summit (Sydney 2017)

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