Mission

Zero Suicide in Health and Behavioral Health Care

What does the model recommend systems do?

Adopting a "Zero-based" mindset happens by routinely and consistently embedding evidence-based practices focused on patient safety and offer hope and recovery for people at risk for suicide. Zero Suicide dismisses the general fatalism about making a dent in the outcomes for those at risk for suicide that persists in health care. The Zero Suicide model represents a galvanizing but feasible approach for identifying and caring for people at risk for suicide. Asking directly about suicide and responding appropriately should and could be as routine as having blood pressure, height and weight checked at every health care visit, yet this normalization has been mostly resisted to date.

Organizations who adopt the Zero Suicide framework are:

• embedding evidence-based elements as a bundle of interventions focused on reducing suicide;
• collecting data to measure both outcomes as well as fidelity to use of these interventions;
• conducting continuous quality improvement to educate staff and improve performance weaknesses;
• normalizing suicide prevention and care practices for staff, people at risk, and their families as the expected standard of care.

Why is Zero Suicide right for health care?

Health care programs that have implemented Zero Suicide are a version of high-reliability organizations (HROs), that via relentless quality improvement and attention to detail are able to perform high-risk work in complex domains without serious accidents or catastrophic events. Health care systems are starting to be comfortable with the language of HROs, and thus implementing safer suicide care practices is natural. Seeing suicide as a never event forces the organization to use best practices, apply continuous quality improvement, and emphasize reducing errors while holding the system to account, not the individual.

Over 38% of individuals have made a healthcare visit (e.g., primary care, emergency department, specialty care, etc.) within the week before their suicide attempt and 95% have had a healthcare visit within the preceding year.1 While this varies across race and ethnicity, these are clearly missed opportunities to identify and care for people at risk for suicide. Health care does not systematically attend to suicide prevention: patients are not routinely or systematically screened, protocols and expectations for any kind of care that directly targets suicidal thoughts and behaviors are absent, and evidence-based practices are used inconsistently, if at all. However, the science of how to address suicide risk directly and based on evidence has improved considerably, and promising practices are now available.

What kind of systems can Zero Suicide benefit?

Reorienting health care to prioritize and reimagine suicide care practices is at the core of Zero Suicide. Zero Suicide has been adopted and adapted for use in health and behavioral health care systems such as hospitals, primary care, emergency departments, outpatient mental health, inpatient psychiatry, substance misuse care settings, Children’s Hospitals, crisis care, corrections, foster care systems, federal, state, and local agencies, Indian Country, health plans and payers, colleges and universities, technology companies, internationally, and others interested in providing the most effective and data-informed suicide care practices available.

• 1Ahmedani, B. K., Stewart, C., Simon, G. E., Lynch, F., Lu, C. Y., Waitzfelder, B. E., ... & Hunkeler, E. M. (2015). Racial/ethnic differences in healthcare visits made prior to suicide attempt across the United States. Medical care, 53(5), 430.