Vermont has the highest rate of deaths by suicide in New England. In fact, we have the seventh highest rate of suicide in the nation (American Association of Suicidology, 2015). Moreover, the rate of suicide in Vermont is rising over the last decade.
“The programmatic approach of Zero Suicide is based on the realization that suicidal individuals often fall through cracks in a fragmented, and sometimes distracted, health care system. A systematic approach to quality improvement in these settings is both available and necessary.”– National Action Alliance for Suicide Prevention http://zerosuicide.sprc.org/
Vermont has begun piloting this approach in Franklin, Grand Isle and Chittenden counties. As this approach is applied in Vermont we are emphasizing four areas of development and implementation of improved clinical practice. These are practices derived from programs that have successfully implemented suicide prevention programs and demonstrated remarkable results in suicide prevention. (Coffey, 2007)
The four areas to improve care are:
Screening – screening for not only depression but suicidality. It will be important to do screening not only in clinical but non-clinical settings as well e.g. schools, home care, social/faith organizations
Assessment – Use of formal assessments instead of reliance on clinical interviews. It is important to remember that while we cannot accurately predict suicide the emphasis in this approach is to plan around suicide safety for moderate to high-risk individuals
Suicide-Focused care – clinical trials have repeatedly shown that while treatment of mental illness reduces the severity and therefore likelihood of death by suicide, however, adding suicide-focused psychotherapy show improved outcomes. Despite these findings, the majority of the clinical workforce is not trained in suicide focused treatment modalities. (Jobes, 2012)
Follow-Up – Following up with individuals means the healthcare system not allowing individuals to fall through the cracks when seeking help. It includes both care coordination between treating clinicians and it includes non-demand care letters which are shown to reduce deaths by suicide in and of themselves. (FleischmannI & Bertolote, 2000)
Next steps: Although we have initiated a pilot of this well-studied and evidence-based approach, we have a long way to go even in the pilot sites and then to implement it statewide.
Thus far, we have trained nearly 120 clinicians in a suicide-focused care treatment modality at Northwestern Counseling and Support Services as well as Howard Center. Given high turnover, we need to continue to expand education in that treatment modality in the two agencies and then bring that to other providers statewide. Mental Health First Aid, Columbia Suicide Severity Rating Scale (CSSRS) as well as other screening tools. Creating rapid-access and seamless care pathways for persons in suicidal crisis must be the emphasis of next steps in implementing zero suicide.
American Association of Suicidology. (2015, May). Fact sheets. Retrieved Oct 19, 2016, from Suicidoloy - U.S.A. SUICIDE: 2014 OFFICIAL FINAL DATA: https://www.suicidology.org/Portals/14/docs/Resources/FactSheets/2014/2014datapgsv1b.pdf
Coffey, E. (2007, Apr). Building a System of Perfect Depression Care in Behavioral Health. The Joint Commission Journal on Quality and Patient Safety, 33(4), 193-199.
FleischmannI, A., & Bertolote, J. (2000). Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries. American Journal of Psychiatry, 157(10), 1592-98.
Jobes, D. (2012, Dec). The Collaborative Assessment and Management of Suicidality (CAMS): an evolving evidence-based clinical approach to suicidal risk. Suicide and Life-threatening Behavior, 42(6), 640-653.