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Marcie Hopkins, U of U Health.
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Zero Suicide - How Do We Get There?
The Zero Suicide initiative has been shown to significantly reduce suicides—and working toward zero suicides is our mission. Rachael Jasperson, Zero Suicide program manager, shares the framework for how we strive for this aspirational goal.
U

tah has the 9th highest rate of suicide in the nation. For people ages 10 to 17, suicide is the leading cause of death. Studies show that 90 percent of people who die by suicide have had contact with a health care provider within the last year. Up to 30 percent have had contact with a health care provider in the last week before taking their lives. 

As health care providers, we are in a unique position to prevent suicide. 

What is the Zero Suicide initiative?

The Zero Suicide initiative is an international health care-system-focused framework designed to prevent suicide across the globe. It reflects a system-wide, organizational commitment to safer suicide care in medical and behavioral health care systems. The framework is based on the premise that individuals struggling with suicide often fall through the cracks in health care systems that are sometimes fragmented and distracted.

Zero Suicide at U of U Health: how we can save lives

Suicide is not fated; it is often preventable. Death is not the goal of suicide. The goal of people who attempt suicide is to relieve themselves of pain. By changing how we think of suicide, and using the structured Zero Suicide framework, we can prevent many suicides. 

This framework informs our goals within U of U Health. While long-term goals, these goals are achievable as we advance this initiative within the coming months and years.

Goal #1: change culture

First, we must create a culture in which we feel comfortable talking about suicide. Many people may avoid asking patients about suicidal thoughts because they don not know how to react. They may fear that they are actually encouraging the person to act on their suicidal feelings by “putting the thought in their head.”

But these sorts of worries are based on myths. Research shows that asking a person if they are suicidal does not increase their suicidal thoughts or ideas. With proper education and training, we can create a culture where we all feel comfortable and prepared to talk to others about suicide.

The Zero Suicide initiative does not rely solely on the efforts of our providers and social workers. It must be ingrained into the entire system as part of who we are and what care we provide. Every team member that a patient interacts with must share the goal of preventing suicide and must develop the tools they need to have difficult conversations. 

Goal #2: standardize processes for screening and treatment

Standardized screenings and processes for suicide risk assessment help people feel more comfortable discussing suicide. They also improve our ability to identify those most in need of treatment. 

Standardizing across a large health care system can be challenging. Currently, every clinic may have their own processes for suicide risk assessment. This approach can mean that screening happens inconsistently, allowing patients to fall through the cracks. We must be able to look across our system and employ consistent strategies so that more people at risk for suicide are identified and cared for.

When there is a standardized process, we can also provide more efficient, knowledgeable care. When someone collapses from a heart attack, providers know what to do. We must achieve the same level of competence, confidence, and comfort when someone expresses suicidal thoughts. 

Goal #3: data and quality

Care for behavioral health conditions occurs across the health system, from primary care offices to the emergency room. We must be able to collect data on all these interactions to determine what quality of care we are currently providing and identify areas where we can improve. We need to develop a system to track and collect this data.

For example, we are in the process of finalizing a data-sharing agreement with the state’s Office of Vital Records. Though we currently receive information from this office on deaths, the data does not include cause and manner of death. We are finalizing an agreement that would send us information anytime someone who is, or was, a patient in our system dies by suicide, allowing us to improve suicide prevention techniques. We currently have no idea how many of our patients die from suicide, so this agreement is vital for tracking improvement in suicide rates. 

Zero is the goal

Though we are in the early stages of this initiative, we have been overwhelmed by the level of support we have received from providers across the system. Our committee is made up of people from all areas of the health care system, from nursing to IT, as well as community members to help us achieve these goals and strive toward zero suicides. 

The conversation about suicide has shifted in Utah and across our health care system. We are ready to talk about this difficult topic and to take on the challenge of preventing suicide. I truly believe that we have the passion and dedication needed to strive toward the goal of zero suicides and save the lives of our patients.

How Zero Suicide works

The Zero Suicide Initiative has seven key components:

Lead. Our leadership, including all managers and directors, are committed to this initiative. 

Train. We train our staff to understand suicide, feel comfortable with suicide and become competent in suicide prevention strategies. 

Identify. We use screening to identify people at risk of suicide.

Engage. Once individuals are identified, we engage with them to ensure they are safe; we determine any lethal means, such as firearms, that they have at their disposal. 

Treat. We use evidence-based treatments to prevent suicide and treat conditions leading to suicidal thoughts. 

Transition. Patients have warm handoffs as they transition from provider to provider when receiving care.

Improve. We continuously improve the quality of our suicide prevention program through data collection and evaluation.

Contributor

Rachael Jasperson

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

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