A concise explainer of the research base for the Lead element of the Zero Suicide approach.

In this podcast trilogy, Rocky Mountain Short host Adam Hoffberg interviews three key Zero Suicide Champions who attended the 50th annual American Association of Suicidology conference. 

In "An Introduction to the Zero Suicide Initiative," Julie Goldstein-Grumet, who oversees the Zero Suicide Institute in her role as the Director of Health and Behavioral Health Initiatives at the Suicide Prevention Resource Center, discusses the foundation of Zero Suicide. She offers strategic direction to improve the effectiveness of behavioral health, clinical care, and primary care providers to recognize and respond to suicide emergencies.

Anthony Pisani of the University of Rochester Center for the Study and Prevention of Suicide discusses his model for suicide safer care, prevention-oriented risk formulation, and the need for a common framework for assessing, communicating, and responding to suicide risk for clinicians, patients, and the medical record in "A New Take on Zero Suicide and Risk Formulation."

Speaking from the Henry For Health System Center for Health Services Research, Brian Ahmandani discusses how the Zero Suicide initiative fits with the Center's investigation of ways to improve the quality, efficiency, and equality of health care. "Suicide Prevention in Health Systems" also discusses recent research findings on suicide preventions in health systems.

"Rocky Mountain Short Takes on Suicide Prevention: Talking to Patients about Firearm Safety" is a conversation about firearm safety between the host, Adam Hoffberg, and Emmy Betz, an emergency room physician at the University of Colorado Hospital. The conversation covers a range of topics regarding lethal means reduction. One of the highlights is a Colorado program called the Colorado Gun Shop Project, which is a collaboration with gun shop retailers, gun range owners, and firearm safety course instructors to promote suicide prevention. The podcast is twenty-six minutes long and can be found at the Rocky Mountain MIRECC for Veterans Affairs Suicide Prevention website.

In this podcast, Jonathan B. Singer, Ph.D., LCSW interviews David W. Covington, LPC, MBA regarding the importance of healthcare systems adopting and implementing Zero Suicide initiatives.

The Real Warriors Campaign is a multimedia public awareness campaign designed to encourage help-seeking behavior among service members, veterans and military families coping with invisible wounds. Launched by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) in 2009, the campaign is an integral part of the Defense Department’s overall effort to encourage warriors and families to seek appropriate care and support for psychological health concerns.

There is an increased focus on providing evidence-based care in both the military and civilian health care systems. Since 1998, the Defense Department (DoD) and Department of Veterans Affairs (VA) have worked together to develop CPGs for treating psychological and physical health concerns. The departments’ working groups create the guidelines based, in part, on the readiness needs of service members and veterans.

The Institute of Medicine defines clinical practice guidelines (CPGs) as “statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.”

CPGs create consistency of care. They can support provider and patient decisions about appropriate care for specific concerns but should not replace a provider’s best judgment.

Potential Benefits for Health Professionals

CPG use can lead to a number of advantages that positively affect both the providers and patients. If implemented correctly, CPGs can:

• Improve quality of clinical decisions and care
• Offer clear recommendations for providers
• Promote efficient use of resources
• Streamline access to resources

Most clinicians-in-training learn to summarize suicide risk in a categorical probability judgment expressed as low, moderate, or high, often with gradations like low-moderate. But what do we really mean when we say a patient is at “low” “moderate” or “high” risk? Risk compared to whom? Compared to when? In what setting? These labels are devoid of context, lack predictive validity, and provide little help when developing plans and responses to prevent suicide.  In this Suicide Prevention Resource Center Director's Corner, Anthony Pisani, PhD explains moving away from a prediction model to a prevention model.

This Joint Commission Sentinel Event Alert aims to assist all health care organizations providing both inpatient and outpatient care to better identify and treat individuals with suicide ideation. Clinicians in emergency, primary and behavioral health care settings particularly have a crucial role in detecting suicide ideation and assuring appropriate evaluation. 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.

This two-page fact sheet features a strengths-based intervention that identifies the needs of youth and the goals that the youth and his or her family will work towards with the assistance of the team and community. 

The goal of this paper is to highlight key steps emergency department (ED) providers can take to establish continuity of care for patients at risk for suicide, and thereby, to substantially reduce the number of suicide deaths and suicide attempts that occur after discharge. The risk of suicide attempts and death is highest within the first 30 days after a person is discharged from an ED or inpatient psychiatric unit, yet as many as 70 percent of suicide attempt patients of all ages never attend their first outpatient appointment. Therefore, access to clinical interventions and continuity of care after discharge is critical for preventing suicide. 

In 2014, six states and their provider partners set out with the Suicide Prevention Resource Center and the National Council for Behavioral Health on the Zero Suicide Breakthrough Series—a project designed to learn how best to support the successful launch and implementation of the Zero Suicide approach under the direction of a state mental health or public health office. State leaders who had already begun the process of launching Zero Suicide initiatives were asked to invite a provider organization to partner with them in the process. Over the course of the nine-month Breakthrough Series period, they were given additional technical assistance and supports to move towards suicide safer care practices. This report details lessons learned throughout the process.