Zero suicide is a concept that is a model for reducing suicide across the country. It essentially integrates questions about suicide for patients at all health care visits. New York State has won a grant to use a Onondaga County as a kind of a test lab to see if it can be successfully integrated into an entire community health system.
"Nearly 50 percent of people who die by suicide had a primary care visit within 30 days of their death," said Dr. Jay Carruthers, New York State Suicide Prevention Director.
That glaring statistic is one reason the idea of integrating suicide prevention into all health and behavioral care systems could be a game changer in preventing suicides. The core concept of Zero Suicide contends that suicide deaths are preventable, but sometimes, suicidal individuals fall through the cracks of a fragmented and distracted health care system.
So, Carruthers said the state, with the help of a $3.5 million federal grant, will create a situation in Onondaga County, where all patients in all settings will be questioned about suicidal thoughts.
"We want to stitch together all the different providers to provide a zero suicide safety net. And that’s never been done," said Carruthers. "Zero Suicide has only been implemented in singular health systems successfully. This is an ambitious goal, but we hope it can get a good start in Onondaga County.”
Onondaga County is urban, suburban and rural, with a higher than average suicide rate for the state, as well as a robust health care system.
“The goal is to see a 20 percent reduction in both suicide attempts and suicide deaths in the county," said Carruthers.
The state has begun training behavioral health specialists in Onondaga County about assessing suicide risk.
The screening in all these medical encounters will be simple, with two questions: Have you thought about suicide? And have you made a suicide attempt?
Dr. Christopher Lucas, a psychiatrist and professor at Upstate Medical University in Syracuse, said any 'yes' answers will lead to six more questions. And then the challenge is keeping track of who may be at risk.
"It’s first having a register of people we are concerned about, and then having automatic reminders when people have failed to show up at an appointment, or cancelled an appointment," said Lucas. "And we do that in kind of a manual way at the moment, but I think we’re going to try to make it much more automated, so really it becomes foolproof.”
Once it’s implemented in the behavioral health arena, Zero Suicide will become standard operating procedures in emergency rooms, primary care offices, whether a patient is being treated for a sprained ankle or sinus infection.
"In terms of preventable deaths, this has much more of an immediate impact than many other things that are screened for, providing it’s brief," said Lucas. "And sometimes it’s doesn't have to be done by doctors. It could be done by nurses, it could be done by EMT’s, it could be done by community workers.”
Then it’s the follow-up to the questions that’s key, especially when someone has reported an attempted suicide. That’s where Dr. Seetha Ramanathan comes in. She is one of two specialists for a program called ASSIP at the state-run Hutchings Psychiatric Center in Syracuse. The Attempted Suicide Short Intervention Program begins with a brief therapy then a regular follow up.
ASSIP has a great track record. First developed in Switzerland in 2013, it reduced suicidal behavior by 80 percent and hospitalizations by 72 percent. Ramanathan likes the way it encourages patients to look at their suicide attempt.
"The therapy starts with a question. 'Tell me the story behind your suicide.' It’s essentially a narrative, which is videotaped and the patent and the therapist sit and watch the tape. They go through the tape and figure out what happened, and what can be changed," said Ramanathan.
She said the key is the patient seeing his or her story.
"Just connecting with the person where they are in a moment of crisis and sitting with a person. 'I am here to listen to the story of your crisis.' I think that helps a lot,” she said.
Dr. Lucas said another key step is creating a plan to cope with suicidal thoughts and feelings that may come up again. It's a kind of suicide action plan.
"What are they going to do when they start to feel stressed, when they start to feel suicidal? Who will they contact? Who will they contact if they can’t find that person? What strategies will they use to make themselves feel better?" Lucas said.
Carruthers believes this collaborative effort could be groundbreaking in the fight against a suicide rate that continues to inch up in this country.
"There are pieces in place, and it’s being done inconsistently. So it’s all about doing this systematically, and setting ambitious goals and holding ourselves to it," he said.