EDC ©2016. All rights reserved. Zero Suicide (Suicide Safe Care) in Healthcare: Background, Concepts and Practice Texas State Health Services Grand Rounds April 2016 Mike Hogan, Ph.D. EDC ©2016. All rights reserved.

Health Care Progress Measured by Death Rates

National Action Alliance for Suicide Prevention Launched Sept 2010

Action Alliance Clinical Care and Intervention Task Force Access at: www.zerosuicide.com EDC ©2016. All rights reserved.

What Did We Learn About Suicide and Health Care Settings? Most suicide deaths are among people in care or recently seen in healthcare Suicide prevention must become a core responsibility of health care organizations and systems We have new knowledge about detecting and treating suicidality. Very little of it is commonly used. The gap between what we know and what we do can be fatal. We must apply new knowledge Preventing suicide deaths in health care requires a systematic clinical approach, not “the heroic efforts of crisis staff and individual clinicians.” We have work to do EDC ©2016. All rights reserved.

Suicide and Health Care Settings 45% of people who died by suicide had contact with primary care providers in the month before death. Among older adults, it’s 78%. 19% of people who died by suicide had contact with mental health services in the month before death. South Carolina: 10% of people who died by suicide were seen in an emergency department in the two months before death. EDC ©2016. All rights reserved.

Suicide in Mental Health Systems Ohio: Between 2007-2011, 20.2% of people who died from suicide were seen in the public behavioral health system within 2 years of death. New York: In 2012 there were 226 reported suicide deaths among consumers of public mental health services, accounting for 13% of all suicide deaths in the state. Vermont: In 2013, 20.4% of the people who died from suicide had at least one service from state-funded mental health or substance abuse treatment agencies within 1 year of death. EDC ©2016. All rights reserved.

Patterns of Suicide in the “Mental Healthcare Neighborhood” Deaths in hospital are unacceptable, and rare TJC: 1089 sentinel events reported 2010-2014 NYS: Most suicide deaths in public mental health care (almost 80%) were among community care clients Of 17% classified as inpatient related, vast majority (85%) were within 30 days of discharge. Within 72 hours post-discharge: 2 times as many suicide deaths as on inpatient units 72 hours-30 days post-discharge: almost 4 times as many deaths as on inpatient units Improvements are needed in inpatient care (assessment, communication, treatment, transition) but the big challenges are in the community

EDC ©2016. All rights reserved. WITHOUT IMPROVED SUICIDE CARE, PEOPLE SLIP THROUGH GAPS Engagement and Support? Treat Suicidality? Reduce Lethal Means? Act for Safety? Ask? EDC ©2016. All rights reserved.

THE TOOLS OF ZERO SUICIDE FILL THE GAPS

THE TOOLS OF ZERO SUICIDE FILL THE GAPS

THE TOOLS OF ZERO SUICIDE FILL THE GAPS

THE TOOLS OF ZERO SUICIDE FILL THE GAPS

THE TOOLS OF ZERO SUICIDE FILL THE GAPS

THE TOOLS OF ZERO SUICIDE FILL THE GAPS

THE TOOLS OF ZERO SUICIDE FILL THE GAPS

EDC ©2016. All rights reserved. THE TOOLS OF ZERO SUICIDE FILL THE GAPS EDC ©2016. All rights reserved.

What Have We Learned About Suicide and Health Care Settings? Most suicide deaths are among people in care or recently seen in healthcare Suicide prevention must become a core responsibility of health care organizations and systems We have new knowledge about detecting and treating suicidality. Very little is commonly used. The gap between what we know and what we do can be fatal. We must apply new knowledge Preventing suicide deaths in health care requires a systematic clinical approach, not “the heroic efforts of crisis staff and individual clinicians.” EDC ©2016. All rights reserved.

A Systematic Approach to Health Care Quality Improvement: Henry Ford Health System EDC ©2016. All rights reserved.

Zero Suicide is… A focus on error reduction and safety in health care. A framework for systematic, clinical suicide prevention in behavioral health and health care systems. A set of best practices and tools including www.zerosuicide.com. Embedded in the National Strategy for Suicide Prevention and Joint Commission Sentinel Event Alert #56. A BHAG (Big, Hairy, Audacious Goal) EDC ©2016. All rights reserved.

EDC ©2016. All rights reserved. 2012 National Strategy for Suicide Prevention: GOALS AND OBJECTIVES FOR ACTION A report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention GOAL 8: Promote suicide prevention as a core component of health care services. GOAL 9: Promote and implement effective clinical and professional practices for assessing and treating those at risk for suicidal behaviors. GOAL 8. Promote suicide prevention as a core component of health care services. Objective 8.1: Promote the adoption of “zero suicides” as an aspirational goal by health care and community support systems that provide services and support to defined patient populations. Objective 8.2: Develop and implement protocols for delivering services for individuals with suicide risk in the most collaborative, responsive, and least restrictive settings. Objective 8.3: Promote timely access to assessment, intervention, and effective care for individuals with a heightened risk for suicide. Objective 8.4: Promote continuity of care and the safety and well-being of all patients treated for suicide risk in emergency departments or hospital inpatient units. Objective 8.5: Encourage health care delivery systems to incorporate suicide prevention and appropriate responses to suicide attempts as indicators of continuous quality improvement efforts. Objective 8.6: Establish linkages between providers of mental health and substance abuse services and community-based programs, including peer support programs. Objective 8.7: Coordinate services among suicide prevention and intervention programs, health care systems, and accredited local crisis centers. Objective 8.8: Develop collaborations between emergency departments and other health care providers to provide alternatives to emergency department care and hospitalization when appropriate, and to promote rapid followup after discharge. GOAL 9. Promote and implement effective clinical and professional practices for assessing and treating those identified as being at risk for suicidal behaviors. Objective 9.1: Adopt, disseminate, and implement guidelines for the assessment of suicide risk among persons receiving care in all settings. Objective 9.2: Develop, disseminate, and implement guidelines for clinical practice and continuity of care for providers who treat persons with suicide risk. Objective 9.3: Promote the safe disclosure of suicidal thoughts and behaviors by all patients. Objective 9.4: Adopt and implement guidelines to effectively engage families and concerned others, when appropriate, throughout entire episodes of care for persons with suicide risk. Objective 9.5: Adopt and implement policies and procedures to assess suicide risk and intervene to promote safety and reduce suicidal behaviors among patients receiving care for mental health and/or substance use disorders. Objective 9.6: Develop standardized protocols for use within emergency departments based on common clinical presentation to allow for more differentiated responses based on risk profiles and assessed clinical needs. Objective 9.7: Develop guidelines on the documentation of assessment and treatment of suicide risk and establish a training and technical assistance capacity to assist providers with implementation. EDC ©2016. All rights reserved.

Joint Commission Sentinel Event Alert 56: Detecting and Treating Suicide Ideation in All Settings “The suggested actions in this alert cover suicide ideation detection, as well as the screening, risk assessment, safety, treatment, discharge, and follow-up care of at-risk individuals. Also included are suggested actions for educating all staff about suicide risk, keeping health care environments safe for individuals at risk for suicide, and documenting their care.” EDC ©2016. All rights reserved.

Elements of Zero Suicide EDC ©2016. All rights reserved.

A Movement and a Mission EDC ©2016. All rights reserved.

EDC ©2016. All rights reserved. Thank You EDC ©2016. All rights reserved.