A New Position on Prevention: The Zero Suicide Approach
The Zero Suicide Approach is a new treatment plan that focuses not only on the patient but also on the importance of the mental health professionals and loved ones in a patient’s life and the role they can play in treatment. This takes suicide prevention a step beyond an individual seeking help and makes it a collaborative group effort.
By using the eight steps laid out in the Zero Suicide Plan, mental health professionals can try to ensure that patients don’t die by suicide; not that fewer patients die by suicide but that no patients do. Zero is the number.
As with any treatment plan, the best way to implement new strategies is to have strong leadership. This means all mental health professionals must make it their priority to learn about any new tools or training methods that are available and use them to the best of their ability. Leadership has long been stressed by the Joint Commission (JC), an agency which accredits hospitals. Leadership also means that the Joint Commission stops giving high marks to hospitals with any suicides. Giving high marks to hospitals with a suicide is misleading the public—the same public the Joint Commission should protect. The JC should also stop hiding important information from the public. It should mandate that all sentinel events be reported to the JC with a full explanation on why the sentinel event occurred. At this point the public does not know how many attempted suicides have occurred in hospitals or within 3 days of discharge. The public should know that the estimates of suicides in hospitals is around 1600 patients every year.
Wanting to help someone at a high risk of suicide isn’t enough. All mental health professionals should receive the proper training to help their patients in the best way possible. The right tools make all the difference. Solid training should start early in professional schools but—mostly —the training is inadequate; this is another leadership issue.
It is important for mental health professionals to identify and assess the suicide risk factors for each patient in their care. Such risk factors include: family and personal history of suicide or prior suicide attempts, feeling like you are a burden to others, feeling like you don’t belong, substance abuse, mental illness, recent loss (such as losing a home or a loved one), other drastic life changes (such as losing a job), and psychological conflict or trauma. Knowing each client’s history and risk factors will help mental health professionals find the best ways to treat their patients. However, knowing risk factors is not enough; professionals must learn how to elicit suicidal thinking.
Interpersonal connection is a vital part of life and even more so for those who are at high risk of suicide. A high risk patient might experience feelings of loneliness or isolation. Regular contact with loved ones and the mental health professionals in their lives though phone calls, visits and messages reminds those patients they are not alone. This method should be used as often as possible.
Much as there are standards of care are when dealing with a patient with ailments such as high blood pressure or diabetes, so too should there be standards of care for treating patients with high suicide risk. “Standard care” is what everyone does and most often wrong. The test is “THE standard of care.” “Standard care” is going 70 mph when “THE standard” is 55 mph. No policeman will accept “well everyone was going 70.”
This method is replacing the common practice of the No-Harm Contract. One reason for this shift is that the No-Harm Contract has not been proven to be effective, nor does it encourage continued care. Unlike the contract, A Safety Plan is created by the clinician and the patient together. They discuss different strategies, triggers and coping techniques the patient has at their disposal and how best to implement them. Through this collaborative effort, the patient is more involved in their own care and they take a more active role in their treatment.
This plan breaks treatment down into two categories:
Cognitive behavioral therapy: This method focuses on helping patients recognize the thoughts or feelings that may overwhelm them and teaching them alternative coping skills. Research has proven this to be an effective tool for suicide prevention.
Dialectical behavior therapy: There are four main components to this therapy: individual treatment, a skills training group, consultation team meetings and phone coaching. As with cognitive behavioral therapy, this method has also proven effective.
The Zero Suicide Approach also focuses on continuing care. Initial treatment isn’t enough. It is imperative that all mental health professionals continue to be involved in a patient’s life, to continually reinforce the teachings and tools provided in the treatment plan.
The medical and mental health professionals must stay on top of a patient’s treatment. They need to use all of the most effective tools at their disposal and know how to integrate those tools into the patient’s treatment plan.
To learn more about the Zero Suicide Approach, click here.