1. Zero Suicide Implementation in St Joseph’s Health Care London Dr
Zero Suicide Implementation in St Joseph’s Health Care London Dr. Sandra Northcott CHAC Innovative Session May 16, 2019

2. St Joseph’s Mental Health Care Programs:
Parkwood Institute
Southwest Centre for Forensic Mental Health Care
PIMH: tertiary mental health with 150 beds – adults, geriatrics, adolescents, Developmental disabilities Outpatient programs – Ambulatory, CDP, geriatric outreach, etc.
SWC: forensics inpatient with 89 beds /forensic outreach
ACT teams 7 4 London, 2 Elgin and 1 Woodstock

3. Overview
The foundational belief of Zero Suicide is that suicide deaths for individuals under the care of health and behavioral health systems are preventable.
For systems dedicated to improving patient safety, Zero Suicide presents an aspirational challenge and practical framework for system-wide transformation toward safer suicide prevention care.

4. Overview Zero Suicide is a commitment… To make suicide a “never event”
To ensure patient safety
To train and support clinical staff to do the demanding work of treating suicidal patients

5. Overview Henry Ford Health System in Detroit
80% reduction in suicide rate
9 consecutive quarters with zero suicides
Has since been implemented across the U.S. and internationally
Has also now been endorsed by the MHCC as best practice (and the OHA)
State why we chose to adopt this at SJHC – 85% of people who die by suicide have had contact with a healthcare provider within one month of their death

6. Zero Suicide Model Seven Essential Elements
LEAD: Create a leadership driven, safety-orientated culture committed to dramatically reducing suicide among people under our care. Include survivors of suicide attempts and suicide loss in leadership and planning roles
TRAIN: Develop a competent, confident and caring workforce. Invest in training such as ASIST

7. Zero Suicide Model Seven Essential Elements
IDENTIFY: Systematically identify and assess suicide risk
ENGAGE: Ensure every patient has a pathway to care that is both timely and adequate. Includes collaborative safety planning and lethal means restriction
TREAT: Use evidence-based treatments that directly target suicidality

8. Zero Suicide Model Seven Essential Elements
TRANSITION: Provide continuous contact and support, especially after acute care
IMPROVE: Apply data-driven quality improvement approach to inform system changes that will lead to improved patient outcomes and better care for those at risk

9. Implementation at St. Joseph’s
Three Phases:
Phase I (July 2016 – December 2017):
Adult Ambulatory and Concurrent Disorders Services
Piloted with ~1,200 outpatients
Phase II (January 2018 – December 2019)
Inpatient mental health, ACT, remaining outpatient programs
Phase III (January – December 2020)
Community partners, partner hospitals

10. Implementation at St. Joseph’s
Project Team:
Project Lead
Clinical Lead
Physician Lead
Project Support Analyst
Working Groups
Steering Committee
Advisory Committee

11. Implementation at St. Joseph’s
Workforce Survey (Ambulatory)
Survey administered to all clinical staff & physicians ahead of implementation in their area
Response rate for Adult Ambulatory ~90%
Themes: low to moderate confidence, comfort, and competence in assessing and caring for suicidal patients; looking for more support by organization following an incident; desire for further training
Follow-up survey at end of pilot: all areas of focus significantly improved
Comfort, confidence, and competence level all increased significantly. Desire for training went way down – staff felt they had received the training for which they asked.
Results used to inform education plan
Also completed survey for all other areas before training – informed training plans, etc.

12. Implementation at St. Joseph’s
Baseline:
Nurses’ Global Assessment of Suicide Risk (NGASR) completed on 48% of Adult Ambulatory clients and 0% of Concurrent Disorders Clients
No formal process for safety planning
Varying skill and comfort levels among clinical staff
Baseline on inpatient units varied – from 0% to ~60%
Coping Plan – still need to boost numbers; sitting around 40-50% complete on admission

13. Implementation at St. Joseph’s
Pilot Results:
Over 90% of patients receive a C-SSRS screener at every visit with their primary clinician
All newly admitted outpatients receive a C-SSRS lifetime/recent assessment
Patients develop a preventative Coping Plan with their clinician
All patients at imminent risk collaboratively develop a Suicide Management Plan
Coping Plan – still need to boost numbers; sitting around 40-50% complete on admission

14. Implementation at St. Joseph’s
Training & Education Provided to Ambulatory Staff
C-SSRS training (online module done in groups)
Applied Suicide Intervention Skills Training (ASIST)
Collaborative Assessment & Management of Suicidality (online videos + supplementary text)
Cognitive Behavioural Therapy for Suicidality (3-day workshop by Beck Institute + consultation sessions)
+ more – mentioned earlier, based on survey results (these are the “official” training programs provided)
We run full-day sessions for inpatient staff
Add about education i.e. MSE

15. Implementation at St. Joseph’s
Training & Education Provided to Inpatient Staff
C-SSRS training (online module done in groups)
Suicide risk formulation, warning signs, risk and protective factors, safety planning
Lethal means restriction and counselling on access
Documentation/Mental Status Exams
+ more – mentioned earlier, based on survey results (these are the “official” training programs provided)
We run full-day sessions for inpatient staff
Add about education i.e. MSE

16. Implementation at St. Joseph’s
Budget
Education:
Pilot: $54,000
Phase II: $80,000
Engagement:
Pilot: $6,000
Phase II: $10,000
Funding provided through St. Joseph’s Health Care Foundation

17. For more information on Zero Suicide:
Website:
Contact:
Katerina Barton:
Sandra Northcott: