Not one more: Coalition of local organizations to pursue Zero Suicide initiative

By Jamie Swinnerton
Tompkins Weekly

 

Recently, the topic of suicide has once again made headlines across the country after the deaths of Kate Spade, a well-known fashion designer, and Anthony Bourdain, a popular television personality and culture critic. But what doesn’t often make headlines are the deaths by suicide of everyday people and the health crisis these deaths are a part of. Here in Tompkins County, a coalition of local organizations are ready to recommit themselves to the fight to end suicide through a health care centered initiative often referred to as Zero Suicide.

Last Monday, the Tompkins County Suicide Prevention Coalition overwhelmingly voted in favor of recommending the Zero Suicide model to countywide healthcare providers. But these organizations don’t want to pursue this initiative on their own. Their recommendation will be sent to the Community Services Board, and hopefully on to the Tompkins County Legislature for consideration.

The Zero Suicide model has already been recommended by the federal and New York state governments to help prevent deaths by suicide by taking a health care centered approach. The model argues that by closing gaps in the health care system, deaths by suicide for individuals already within the health care system are preventable. In 2016, the New York State Office of Mental Health published their prevention plan, titled “1,700 Too Many.” According to the study, while deaths from cancer, heart disease, and strokes have been declining since 2003, suicide rates have been rising. Here in Tompkins County, the rate of suicide per 100,000 people was 13.8 in 2015.

More recently, a study from the Center for Disease Control released new data on national rates. The national rate has increased 25.4 percent from 1999 to 2016. According to the CDC, more than half of people who died by suicide in this time period did not have a known diagnosed mental health condition at the time of death. But the statistics that a Zero Suicide approach are concerned with have to do with finding the cracks in the health care system. For those with known mental health conditions, just over half were in treatment at the time of death, and around two-thirds had a history of treatment for mental health or substance abuse disorders.

Here in Tompkins County, the area is lucky to have several organizations working to bring awareness to mental health issues, end stigma, and work toward implementing solutions. While not a health care organization, The Sophie Fund is a local not-for-profit that aims to support local organizations that do provide health care services and bring more awareness to mental health issues. The organization was started in 2017 by Scott MacLeod and Susan Hack, the parents of Sophie Hack MacLeod, a Cornell University student who died by suicide in 2016. The Fund has been a key player in bringing the Zero Suicide model to the county, starting its advocacy in 2016 by engaging local leaders on the issue and helping to create the county coalition last year.

“This is not an awareness project, it’s not a fighting stigma project, those may be byproducts of it, but this is a policy that is designed to improve suicide prevention within health care systems,” said MacLeod.

Several weeks ago, MacLeod brought a presentation about this initiative, along with data from the recent CDC study, to the county Health and Human Services Committee. Among the many statistics that his presentation include were several highlighting the cracks in the health care system that the model hopes to address. What the data shows is that a large majority of people, around 80 percent, who die by suicide had health care visits in the year prior to their death. About 45 percent of those had a primary care visit in the month before their death.
“We want to have this broad health care community implementing tools and strategies that are proven to catch people in their most vulnerable times,” MacLeod said.

When the Fund began advocating within the community it quickly found local partners ready and willing to engage on the topic and interested in learning more about the Zero Suicide initiative. Late last year the Fund held an expert briefing at the Statler Hotel on the Cornell University campus and invited a select number of local health care leaders to learn more. Since then, the Fund has been focusing on getting these leaders engaged with the initiative, which will take time and concerted effort to put into place.

Last week’s meeting was the next big step. The event was both a briefing for the community about what the initiative is about, and a confirmation that the coalition wanted to support sending a resolution in support of the initiative to the county legislature for a formal vote. It succeeded in both. The community meeting brought in around 50 attendees to learn more about the initiative.

At the meeting four of the leaders (Tompkins County Mental Health Services, Cayuga Area Plan/Preferred, Inc., the Alcohol and Drug Council, and Cornell Health) present at last week’s meeting stepped up to become Zero Suicide Champions, meaning they will commit to the model and report back to the coalition next year. Cayuga Medical Center has already committed to the Zero Suicide model and works closely with many of the organizations within the coalition.

“We’d like to see those public commitments from leaders as soon as possible, we’d like to see implementation as soon as possible, and then that needs to trickle down to everyone who is providing mental health services here in the community,” MacLeod said, adding that he hopes it would eventually trickle down into the very culture of the community.

The model laid out by Zero Suicide is meant to help the health care system but can be applied to almost any organization that has any kind of interaction with people in need of mental health services. This includes such institutions as schools, and law enforcement. The second step of the model, after committing to it, is to train your workforce so that everyone understands what safe suicide care is and how to utilize it. Suicide prevention training is given to all employees as is appropriate to their role. Even within the health care system here in New York, 64 percent of health providers surveyed in 2014 received no specialized training, and 33 percent did not feel they had sufficient training to assist suicidal patients.

Suicide Prevention and Crisis Services is an Ithaca based nonprofit with a mission to promote constructive responses to crisis and trauma. For area residents in crisis, the SPCS crisis hotline (800-273-TALK) offers free and confidential counseling 24 hours a day, seven days a week. For organizations that want to become better educated about talking to people who may be suicidal about these thoughts, the SPCS is the place to go. As the coalition moves forward with the Zero Suicide model, the SPCS will be playing the role of educator for at least one of the recent Zero Suicide Champions: Cayuga Area Plan/Preferred, which represents local primary care providers.

“We partnered with them to actually start helping us with education to our practices and our providers about suicide,” said Rob Lawlis, CAP’s Executive Director.

Before the coalition meeting last week, CAP had already reached out to SPCS to broaden their cooperation and relationships with organizations outside the typical scope of health care. It was because of this relationship that CAP was able to commit to the model without any hesitation.
For Lawlis, and by extension CAP, it was the statistics about the majority of people who died by suicide who were not given a mental health diagnoses that proved how important it is for the health care system to expand its thinking and relationships.

“That’s the kind of thing that health care providers and everybody that’s working to care for patients needs to learn more about,” Lawlis said. “For us, partnering with Suicide Prevention and Crisis Service and committing to the Zero Suicide initiative, the real starting point is just education and understanding and figuring out what the right way for us as a community is to better serve people in crisis or at risk.”

The Zero Suicide model is a holistic one with a focus on health care. The strategies the model uses include training staff to spot the signs of someone with suicidal thoughts and how to talk to people about these thoughts, screening for suicide ideation through more direct conversation, utilizing evidence-based interventions, mandates improvement for continuum of care for individuals who have been identified as having suicidal thoughts (this means there is more thorough care at each step, the individuals are not simply sent home without follow-up), and treating suicide as a presenting problem.

“The idea of Zero Suicide is that as many people as possible in the whole health organization or institution have been at least suicide aware, which means they’re not afraid to say ‘Do you have any thoughts of suicide?’” said Lee-Ellen Marvin, Executive Director of SPCS. “So, we hope to be a major contributor to the big education process that has to happen wherever Zero Suicide is adopted.”

Even though SPCS has been aware of and promoting the Zero Suicide model wherever it could, Marvin said she is looking forward to learning more about how SPCS can self-evaluate and implement more, or new, ideas from the Zero Suicide model kits available to organizations that pledge to follow the model.

“We know of suicides in Tompkins County of people who were in the health care system and we have reason to believe that there were gaps that they fell through and that if we are all on board with Zero Suicide in Tompkins County we’re going to close those gaps and it is going to help, without a doubt,” said MacLeod.

As an observer, MacLeod has seen the positive impact that a supportive community can have in preventing suicide by providing hope through awareness.

 

How do you know if someone is having thoughts of suicide?

 

Suicide Prevention and Crisis Services is a local organization working to help people in crisis. Their 24/7 hotline number is 1-800-273-8255. Trained volunteers are available at any time to help if you are having thoughts of suicide or just need to talk to someone about your emotional state. If you would prefer to talk over text message, text GOT5 to 741741 for the crisis text line. The hotline can also be a resource for people who want to help their friends, family, or patients who may be having thoughts of suicide.

Lee-Ellen Marvin is the Executive Director of Suicide Prevention and Crisis Services. Marvin said there are several things to look for if you suspect that someone you know might be having thoughts of suicide: -Feelings. If someone appears to be feeling despairing, desperate, angry, or hopeless, it might be possible that they are also thinking about suicide.
-Actions. If someone is behaving recklessly and indulging in alcohol or drugs more than usual, generally not paying attention to their personal well-being, self-isolating, or giving away treasured possessions these could be signs that they are having thoughts of suicide.
-Circumstances. If you know that someone has recently had multiple difficulties in their life like a loss of a loved one, a break up, losing their job, etc. and they have been struggling with mental health, reaching out to talk about their mental health is important.

 

How do you start the conversation with someone you suspect of having suicidal thoughts?
Marvin takes a direct approach by asking people that might be having thoughts of suicide questions like ‘Do you ever have thoughts about killing yourself?’ or ‘Do you ever think about going to sleep and never waking up?’ Once you know that someone is having these thoughts, the next step is to keep talking about it and finding out what has gotten someone to a place that they feel so badly that they are having these thoughts. Listening, really listening to someone, without berating them for having these thoughts, is important. Instead, listen to find out why. Stay connected, isolation is dangerous. Pull together a network to keep them connected often.

Helping to create an action plan for someone with suicidal thoughts, led by the person having these thoughts, is an important way to support someone going through crisis. The Suicide Prevention and Crisis Services can help friends and family learn more about what they can do to help, and even point out what not to do in situations such as these.