Transforming Systems for Safer Care

Suicide deaths for patients at risk of suicide inhealth and behavioral health systems arepreventable. For systems dedicated toimproving patient care and outcomes, the ZeroSuicide framework presents both an aspirationalchallenge and a way forward.

People who are dying by suicide are touching thehealth care system. 83 percent of those who die bysuicide have seen a health care provider in the yearbefore their death (Ahmedani et al., 2014). Only 29percent of those who died in the past year were seenin outpatient behavioral health (Luoma et al., 2002). Across health care disciplines and settings, there aremany opportunities to identify and provide care tothose at risk for suicide; however, suicide preventionmust first be seen as a core responsibility of healthcare. The Zero Suicide framework is defined by a system-wide, organizational commitment to safer suicidecare in health and behavioral health care systems. It represents a culture shift away from fragmentedsuicide care toward a holistic and comprehensiveapproach to patient safety and quality improvement—the most fundamental responsibility of health care—and to the safety and support of staff, who do thedemanding work of treating and caring for suicidalpatients.

Elements of Zero SuicideZero Suicide Framework

1

2

3

4

5

6

7

Lead system-wide culture change committedto reducing suicides

Train a competent, confident, and caringworkforce

Identify individuals with suicide risk viacomprehensive screening and assessment

Engage all individuals at-risk of suicideusing a suicide care management plan

Treat suicidal thoughts and behaviors usingevidence-based treatments

Improve policies and procedures throughcontinuous quality improvement

Transition individuals through care with warmhand-offs and supportive contacts

Education Development Center © 2018 All Rights Reserved

Zero Suicide fills the gaps that patients at risk for suicide often fall throughusing evidence-based tools, systematic practices, training, and embeddedworkflows. Continuous process improvement drives this framework toensure organizations deliver quality care, routinely examine outcomes, andremain committed to fidelity. The Zero Suicide approach builds onsuccesses supported by data in health care organizations, including HenryFord Health System and Centerstone. With a focus on suicide care using such rigorous quality improvementprocesses, Henry Ford Health System demonstrated stunning results—a 75percent reduction in the suicide rate among their health plan members(Coffey 2007). Centerstone, one of the nation’s largest not-for-profitCMHCs, saw a reduction in suicide deaths from a baseline of 35 per100,000 to 13 per 100,000 after implementing Zero Suicide for 3 years.

To assist health and behavioral health agencies in theiradoption of the Zero Suicide framework, the SuicidePrevention Resource Center (SPRC), federally funded bythe Substance Abuse and Mental Health ServicesAdministration (SAMHSA) offers a free and publiclyavailable evolving online toolkit that includes modulesand resources to address each of the elements of ZeroSuicide.

The Zero Suicide Institute at EDC provides expertconsultation and guidance to health andbehavioral health care organizations implementingthe Zero Suicide framework for safer suicide care.Organizations contract with the Zero SuicideInstitute for the experience and tools needed toaccelerate Zero Suicide adoption.

Visit the Zero Suicide Toolkit

Zero Suicide Institute

www.zerosuicide.com

Zero Suicide Results

www.zerosuicideinstitute.com

Ahmedani, B. K., et al. (2014) Health care contacts in the year before suicide death.Journal of General Internal Medicine 29(6):870-7.  Luoma, et al. (2002) Contact with mental health and primary care providers beforesuicide: a review of the evidence. American Journal of Psychiatry 159(6): 909-916. Coffey, C.E. (2007). Building a system of perfect depression care in behavioralhealth. Joint Commission Journal on Quality and Patient Safety 33(4):193-9.

For more information, please contact us at:

zerosuicide@edc.org

@ZSInstitute

It is critically important todesign for zero even whenit may not be theoreticallypossible. When you designfor zero, you surfacedifferent ideas andapproaches that if you’reonly designing for 90percent may notmaterialize. It is aboutpurposefully aiming for ahigher level ofperformance.

Thomas Priselac, CEOCedars Sinai Medical Center