Let’s Talk Zero Suicide Model

Let’s Talk Suicide Prevention Strategy
July 23, 2020
Podcast with CMHA Windsor Essex
August 21, 2020

Let’s Talk Zero Suicide Model

Last time I wrote about suicide statistics and the need for a Federal Suicide Prevention Strategy.  Today I want to talk about the Zero Suicide (ZS) Model put forth by the National Action Alliance for Suicide Prevention. This is a framework and resources to coordinate a multilevel approach to implementing evidence-based practices for suicide prevention. It is founded on the principle that death by suicide is preventable for patients in behavioral health systems.

There are Four components (Identify, Engage, Treat, and Transition) that address aspects of clinical care, while the other three (Lead, Train, and Improve) concern administrative approaches. Let’s look at them in the order they are presented on the Zero Suicide website.

Lead – There are two main goals in this section. The first is leadership mobilizing staff to believe that suicide can be prevented. The second is an unwavering focus maintaining that zero suicides is the goal. To achieve these goals leadership must put resources, training and supports in place.

Train –  Zero suicide relies on excellent care the moment a client walks in the door. Staff must be trained and feel confident that they can provide the best care.

Identify – Every new client or patient is screened for suicidal thoughts and behaviors.

Engage – every patient who is identified as being at risk for suicide is closely followed. He or she is engaged and re-engaged at every encounter no matter the reason for the visit.

Treat – The research evidence strongly supports targeting and treating suicidal ideation and behaviors specifically and directly, independent of diagnosis, as well as any diagnosed mental health or substance abuse problem.  Newer models of care suggest that treatment and support of persons with suicide risk should also be carried out in the least restrictive setting.

Transition – Organizational policies provide guidance for successful care transitions and specify the contacts and supports needed throughout the process to manage any care transition. This would mean it is, in conjunction with the client, written down and provided to client and kept in their chart as well as shared with any outside care providers that are playing a role in the person’s care plan.

Improve – A lot of this has to do with tracking information such as care plans and unfortunately when a suicide does occur. Only through fidelity of the information tracked can improvements be made.

Let’s do a case example to show the differences between a Zero Suicide approach and a more conventional approach:

37 year old female presents at emergency room with suicidal thoughts, a plan and a deeply troubled husband who does not know how to keep her safe. They wait in a small room for 6 hours and a Psychiatrist comes to see them. The patient is asked four or five questions and divulges that she intends to take a bottle of pills. Psychiatrist says she sympathizes but sends the patient home. They are not given any follow up information, no instructions on what to do next. The next night the patient is back in the ER where a nurse rolls her eyes and says “Oh you again” and puts the couple in a gurney area surrounded by medically ill people. They are kept waiting for 11 hours and are moved repeatedly in the ER. The on call psychiatrist decides to admit the patient. She is brought up to the Psychiatric unit and her husband is told to leave. He is not given any information on what will happen next or how to be in contact with his wife. Throughout her hospitalization he will not be given any information despite her requests to include him in meetings with the doctor. She will spend 11 days on the unit. Each day the psychiatrist will visit for 2 minutes to ask if she feels well enough to go home and if she does not respond favourably he will likely increase her medications. She will meet with a social worker to give them a social history and one day they will take her aside, while she has trouble keeping her eyes open due to medications, and provide her with a diagnosis. She will cry and ask for her husband to be included and the doctor will walk out of the room. There is no programming or counselling during the day – aside from Occupational therapy which is an art room with broken and missing pieces and endless colouring pages. No one will talk about plans for the future or how to avoid coming back to this place. No one provides treatment. It is merely a warehouse for the mentally ill.

Now let’s do the Zero Suicide case study:

37 year old woman presents at the Emergency Room (ER) with her husband with plans of suicide. They are shown to a quiet area and a nurse comes in within the hour to complete a suicide risk assessment. The assessment shows several areas that the woman is at risk for and the on call psychiatrist is called. The couple is informed it will be a wait. When the psychiatrist arrives he determines there is no psychosis and no need for hospitalization. Instead he talks to the patient and they determine that a course of medication may be helpful. The psychiatrist writes a prescription and calls the womans doctor to arrange an appointment for the next day. The psychiatric nurse sits with the couple and creates a crisis response plan which includes steps the woman can take to be safe at home. Her husband is active in creating this plan. The nurse indicates she will call the woman the next day and the woman indicates she feels safe enough to return home.  The couple is given emergency numbers to call should they need immediate assistance.

I don’t know about you but the second seems like a much better outcome for everyone.

Tina Szymczak
Tina Szymczak
Tina Szymczak is a 40-something mom and wife with two spirited boys. She has worked in early intervention and as an advocate resource for families with a loved one with a disability. Now she also writes a blog about raising children with complex needs, trying not to lose your sense of self as you parent, and her struggles with mental health.

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