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.

Lead 

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.   

Train

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. 

Identify

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. 

Engage

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.”

Safety Planning

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. 

Treat

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. 

Transition:

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.

Improve:

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.

Study shows that the first week and first year after diagnosis have elevated risk

While it’s well-known that people suffering from cancer also face high levels of distress and psychiatric symptoms, some research indicates a specific link between the cancer diagnosis itself and death by suicide.

In one study, researchers reviewed medical records on 14,000 people, 786 of whom had been diagnosed with a type of cancer. The study found that among those with a cancer diagnosis, the overall suicide rate doubled compared to the cancer-free population – with significant increases beyond that in the time immediately following the diagnosis.

According to the study results, the risk of suicide increased by a factor of 12 within the first week after diagnosis. That risk tapered off over time, but remained high, as patients diagnosed with cancer were five times more likely to die by suicide within 12 weeks of the diagnosis and three times more at risk within the first year after diagnosis.

Significantly, the research also found a link between prognosis and suicide risk. Those patients who were diagnosed with more deadly cancers, as well as those who were also suffering from another medical condition, were more likely to die by suicide. That suggests that a feeling of hopelessness was partially to blame for their deaths.

Intervention after diagnosis can prevent suicide

One of the most persistent suicide myths says that when people want to attempt suicide, nothing can be done to stop them.  The reality is that a person’s urge to end his or her own life will pass with time. The study results bear this out, as the suicide risk was observed to be strongest right after diagnosis – when the situation seemed most dire – and tapered off substantially as people went on living after being diagnosed with cancer.

Suicide prevention attorney Skip Simpson knows that compassionate—don’t gloss over the word; it is important—intervention can make all the difference for a suicidal person, even someone suffering from a disease as grave as cancer. Most people who are prevented from dying by suicide recover from their impulses to take their own lives. Even someone who seems hopeless still has the capacity to face cancer with determination and a will to live.

Sadly, too many patients never have that chance. Doctors who specialize in treating cancer rarely have the mental health training or experience needed to recognize the warning signs that a patient may be at risk of dying by suicide. Too many patients die while their lives are in the hands of people who are supposed to protect them.

Friends and family members need to be aware of the heightened risk of death by suicide in the weeks and months following a cancer diagnosis. By proactively intervening and encouraging people to seek help, it’s possible to protect patients when they are at their most vulnerable.