9/14/2016. Why Zero Suicide? What is Zero Suicide? The Development of Zero Suicide. Implementing the Elements of Zero Suicide.

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1 Debi Traeder North Central Health Care, Wausau Shel Gross Mental Health America WI, Madison Laure Blanchard, LPC, NCC North Central Health Care, Wausau, WI Kimberly Propp, LPC Jefferson County, Jefferson, WI Sue Jungen, CSAC, ICS Co-Chair Zero Suicide-Tri-County Region Samaritan Counseling and Baeten Counseling Kathleen Fuchs, PhD Co-Chair Zero Suicide-Tri-County Region NEW Mental Health Connection Board Why Zero Suicide? What is Zero Suicide? The Development of Zero Suicide. Implementing the Elements of Zero Suicide. 1

2 So often, we hear, How can you say this or promote it? it s impossible to reach such a goal! But if our goal isn t 0 what number should we use?! Why Are We Here Talking About it? Burden of Suicide Report Findings WI averaged over 725 suicide per year 43% were under care 51% had mental health issues 26% had alcohol issues 13% had substance abuse issues Studies have found that people who die by suicide have seen a clinical professional in the past 1-2 months In the month before their death: Half saw a general practitioner 30% saw a mental health professional In the 60 days before their death: 10% were seen in an emergency department 2

3 Zero Suicide is based on the realization that suicidal individuals often fall through multiple cracks in a fragmented and sometimes distracted health care system, and on the premise that a systematic approach to quality improvement is necessary. The foundational belief of Zero Suicide is that suicide deaths for individuals under care within health and behavioral health systems are preventable. It presents both a bold goal and an aspirational challenge. Suicide should be a never event. Zero Suicide is a culture shift. Over the decades, there have been many instances where individual mental health clinicians have made heroic efforts to save lives, but systems of care have done very little. Dr. Richard McKeon Suicide Prevention Branch Chief SAMHSA The work of Henry Ford Health Systems Developed the Perfect Depression Care Model suicide prevention the primary goal Based on the strategy of preventing medical errors like falls, medication passing, etc. Not punitive programming, building trust and learning from experience A fundamental change in how things are done Suicide prevention part of the entire system of care, not individual clinicians or doctors If we re providing perfect depression care no one will die by suicide. 3

4 The elements of Perfect Depression Care: Screening all clients Protocols based on level of risk Means restriction Use of evidence-based treatments Root cause analysis following deaths. Requires a just culture Air Force Suicide Prevention Initiative Suicides dropped by 1/3 over six years. Maricopa Suicide Deterrent System Project 38% reduction among SMI All three programs demonstrate the ability to dramatically reduce suicide in a boundaried population. 4

5 National Action Alliance for Suicide Prevention Clinical Care and Intervention Task Force Suicide Care in Systems Framework Suicide Prevention Resource Center Toolkit Academies Zero Suicide Toolkit Lead - leadership-driven, safety-oriented culture Train - competent, confident, and caring workforce Identify - suicide risk among people receiving care Engage - every individual has a pathway to care that is both timely and adequate to meet his or her needs Treat - effective, evidence-based treatments Transition - continuous contact and support Improve - data-driven quality improvement approach Joint Commission Sentinel Event Alert Issue in Feb Suggested actions incorporate many of the principles and practices of Zero Suicide. Zero Suicide is now the standard of suicide care for health care settings. 5

6 Wisconsin Perfect Depression Care Learning Communities: 2013 and 2014 Wisconsin State Zero Suicide Academies: 2015 and organizations trained to implement these models. These are their stories. Make an explicit commitment to reduce suicide deaths This starts from the top, down. Having a communications plan, readiness of the organization Competing priorities within the organization The Zero concept Develop a confident, competent and caring workforce. Treating the suicidality vs. treating the mental illness Trainings out there: QPR Question, Persuade, Refer AMSR Assessing and Managing Suicidal Risk CALM - Counseling on Access to Lethal Means MHFA Mental Health First Aid and Youth Mental Health First Aid ASIST Applies Suicide Intervention Skills Training CAMS Collaborative Assessment and Management of Suicidality Others Improving clinical supervision 6

7 Identify EVERY person at risk for suicide. New EMR Electronic Medical Records using data from medical records PSC Pediatric Symptom Checklist screening in physicians offices PHQ-9 Patient Health Questionnaire self-administering, then assessment C-SSRS Columbia Suicide Severity Rating Scale free online training, reduces false positives Engage clients in a suicide care management plan Belongingness and Burdensomeness Peer specialists Motivational interviewing Safety Planning Treat suicidal thoughts and behaviors directly Multi-Systemic Therapy (MST) Collaborative Assessment and Management of Suicidality (CAMS) Dialectical Behavior Therapy (DBT) Cognitive Behavioral Therapy - Suicide (CBT-S) Trauma-informed Care (TIC) Adverse Childhood Experiences (ACEs) 7

8 Follow patients through every transition in care C-SSRS in varied settings (jail, for example) Project BOOST understanding at discharge Warm hand-offs to other cares, groups Caring contacts Apply data-driven quality improvement No-blame approach Evidence- based tools for data gathering What data to gather, where it is stored Death review teams Incident review Systems review Employee assessment review Individual safety and care review North Central Health Care Story 8

9 The importance of the national efforts ZS toolkit Prevent Suicide Wisconsin Teleconferences Supports website Contact: Shel Gross Mental Health America-WI Debi Traeder North Central Health Care 9