1. NIATx Team Diane Mandler and Lisa Anderson

2. BASELINE DATA 2013: 7 Clients died by suicide Outpatient wait list: 6 weeks for a psychiatrist and 4 weeks for a therapist. ORIGINAL AIM Reduce client suicide rate from 7 to 0. SECONDARY AIM Shorten outpatient waitlist from weeks to days.

3. PERFECT DEPRESSION MODEL Next day follow up Weapons/means restriction Family Involvement Adverse Event Analysis Zero suicide philosophy PRIORITY ACCESS MODEL (P.A.M) For clients with a moderate or severe level of need, screened by Crisis Phone Staff. Priority Access appointments available Monday-Friday. Outpatient and Crisis Therapist share responsibility for schedule Schedule appointment with psychiatrist and therapist at time of PAM appointment.

4. PERFECT DEPRESSION MODEL SURVEY – Pretest, Post-test and Re-test Do you think suicide can be prevented? – Strongly Agree18%57%40% – Agree56%32%56% – Neutral15%11%4% – Disagree8%00 – Strongly Disagree3%00 Do you believe that some people will attempt suicide no matter what – Strongly Agree26%04% – Agree51%3%20% – Neutral8%34%20% – Disagree15%37%36% – Strongly Disagree026%20% Seeking collateral information on people who are suicidal is important – Strongly Agree54%64%84% – Agree25%28%16% – Neutral3%00 – Disagree13%4%0 – Strongly Disagree5%4%0 Most individuals who are suicidal are ambivalent about attempting suicide – Strongly Agree54%64%84% – Agree25%28%16% – Neutral3%00 – Disagree13%4%0 – Strongly Disagree5%4%0

5. PRIORITY ACCESS MODEL  Decreased wait list time  Reduced hospitalizations  Increased client and staff satisfaction  Decreased no show rate from 50% to 11%  Increased revenue

6. PERFECT DEPRESSION MODEL Remind staff to ask about means restriction, especially firearms. Continue to educate staff regarding the philosophy of zero depression PRIORITY ACCESS MODEL Easier to start than believed by administration and staff. Some staff struggle with change and expect resistance Move forward no matter what

7. PERFECT DEPRESSION MODEL Begin to collaborate with community to decrease suicide rate Nurture stronger belief in zero suicide as a goal. PRIORITY ACCESS MODEL Start walk-in clinic for increased access to services Survey clients to determine level of satisfaction