zero suicide 7 elements b header
Marcie Hopkins, University of Utah Health
wellness
7 Essential Elements of Suicide Care
A step-by-step discussion of the 7 elements of suicide care.
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eath by suicide is preventable and suicide specific treatments work. Although many suicide risk factors are well understood, it’s been hard to identify which patients are at risk because health care systems have struggled to implement comprehensive screening for mental health problems or suicidal ideation. The Zero Suicide Program is designed to fix these problems, not only with improved screening, but also by providing specific care for our suicidal patients. 

Until now, we have relied on the heroic efforts of our health care providers to prevent suicide. The Zero Suicide program offers a systemic approach to allow our organization to address at-risk patients. Zero Suicide requires a system-wide commitment and teamwork to reduce suicides. 

These seven elements of our Zero Suicide initiative can help us establish a lasting framework for our health care institution. Only by applying all of these elements can we truly activate change.

The 7 essential elements of suicide care

1. Lead system-wide culture change committed to reducing suicides. 

The Zero Suicide initiative requires culture change, which is supported by system leaders. U of U Health leadership have given this program their full support. Leaders are responsible for creating the policies and procedures that emphasize safe suicide care. 

Our goal is to prevent suicide by providing specific support and care for patients within a safe, judgement-free environment. 

Early steps:

  • Increase understanding that suicide is preventable, but it takes all of us.

  • Support providers and staff to become comfortable with suicidal patients.

  • Engage everyone’s commitment to improve health care procedures for suicidal patients.

 Through public campaigns, policy linkages and leadership commitment, our system will demonstrate a unified effort to reduce suicides.

2. Train a competent, confident, and caring workforce.

Safe suicide care begins the moment a patient walks through the doors. All employees must be prepared to deliver quality care and support. Staff training can educate employees on up-to-date resources and principles of the Zero Suicide philosophy. In addition to understanding Zero Suicide policies and protocols, training will also include basic techniques on the assessment, management, and treatment planning for patients at-risk. Our employees provide a crucial line of defense against suicide. Comprehensive training will help them deepen their skillsets, increase their confidence, and improve the effectiveness of safe suicide care.

3. Identify individuals with suicide risk through comprehensive screening and assessment. 

By implementing standardized screening processes for all patients, we can better recognize the risk factors and warning signs of patients at risk for suicide.  

We can use screening processes to generate a risk formulation for at-risk patients that includes:

  • Input from psychiatric consults, family members, and practitioners.

  • Detailed evaluation of the patient’s environment. 

  • Documentation of other risk factors, such as past behavior and stressors. 

 We don’t want at-risk patients to slip through the cracks. In-depth screening procedures and personalized risk formulations will help us provide the safest suicide care.

4. Engage all individuals at-risk of suicide using a suicide care management plan.

One of the best ways we can combat suicide is through suicide care management plans. These plans create a continuous pathway to care for at-risk patients. We can monitor and update their status in their electronic health record (EHR). 

We can also implement suicide care management policies to engage with patients. These policies should include:

  • Screening tools.

  • Same-day access to behavioral health professionals for further evaluation.

  • Protocols for safety planning, crisis support planning, and lethal means reduction.

  • Processes for communicating care options to patients.

  • Ongoing contact with patients for continual support outside of the hospital.

5. Treat suicidal thoughts and behaviors using evidence-based treatments.

The Zero Suicide program directly targets clients’ suicidal thoughts and behaviors, as well as any other underlying mental health issues. Research has shown that treating suicidal ideation independent of other existing mental health concerns can accelerate the patient’s recovery. 

We will provide evidence-based care by:

  • Standardizing patient education materials about different treatment options.

  • Charting regularly on patient progress.

  • Introducing suicide-specific interventions.

We will also collaborate with local agencies and partners to carry out treatments in the least-restrictive settings possible. Some of these support systems include:

  • Crisis center hotlines.

  • Brief interventions.

  • Partial or inpatient hospitalizations with suicide-specific care.

  • Telemental health.

6. Transition individuals through care with warm hand-offs and supportive contacts.

Care transitions can be stressful for patients. We can ease changeover periods to ensure that they continue with appointments and treatments.

To better support patients, we will develop policies for safe care transitions. These policies will:

  • Develop contacts with outside organizations to assist with patient care.

  • Train staff on transitional policies and procedures. 

  • Educate patients on models of care and treatment rationales.

  • Document transitions in EHR.

7. Improve policies and procedures through continuous quality improvement.

To promote data-driven quality improvement, we will evaluate and record new information in electronic health records. We can monitor progress on two main criteria:

  • Conformity to the elements outlined in the Zero Suicide model.

  • Expected patient care outcomes.

How we’ll get there

Ther first year will be dedicated to generating system-wide awareness of the Zero Suicide program. Leaders will partner with marketing to launch an internal campaign. Through Zoom classes and in-person workshops, we will incorporate integrated suicide prevention education into employee training. 

Next, we will develop foundational platforms for data sharing, and introduce more standardized screening practices and safety plans into patient care. Finally, we will improve our Safe Care Transitions Program for behavioral health patients.

This program is a call for system-wide change. It’s time to break down existing boundaries and create an open dialogue about suicide prevention. We must rally together and transform into a culture that values the mission of safe, high-quality suicide care.

Contributor

Rachael Jasperson

LCSW, PhD, MBA, Zero Suicide Program Manager, University of Utah Health

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