Suicide: It’s not inevitable

Could we say ….
that even one death resulting from a suicide is acceptable in mental illness? Clearly, we wouldn’t want that one person to be OUR relative, neighbor, friend, right?  That one person can’t be anyone’s relative, neighbor or friend. So zero deaths by suicide should be our goal.

Are you a clinician dissatisfied with the suicide prevention approach used at your center? Or perhaps are you a survivor concerned that suicidal feeling will recur and you question who or what is going to truly help you??? Or maybe you’re someone whose relative attempted suicide last year and was found in time, and you’re hunting for a more proactive and effective suicide prevention program but unsure where to turn?

I have an approach that I’d like you to consider for your clients, or for yourself or for your loved ones: I recommend the Zero Suicide ( program.  Zero Suicide, an approach and program developed for the health care system, views suicide deaths as a preventable outcome and insists that the goal of zero suicides among persons receiving care is a goal that system can and should accept!

Zero Suicide, a project of the Suicide Prevention Resource Center (SPRC), grew from work done by the National Action Alliance on Suicide Prevention (NAASP). It is a specific set of tools and strategies. It is a concept, a practice, and a goal.

NAASP views suicide as preventable and the goal of zero suicides as a goal we should all aspire to accomplish. The word ALL is significant. This initiative requires the engagement of suicide attempt survivors, family members, policymakers, and researchers, and the clinic or hospital. The effort seen by the NAASP and Zero Suicide is a community endeavor—an effort including but beyond health care providers and clinicians.  Beyond heroic efforts of individual practitioners.

Where did this Zero Suicide program come from? The approach builds on work done in several health care organizations, including the Henry Ford Health System (HFHS) in Michigan.  The Henry Ford Health System had already applied a rigorous quality improvement process to problems such as inpatient falls and medication errors. They also realized that mental and behavioral health care could be similarly improved … an individual involved with the quality improvement group challenged the team:  “Why don’t we adopt zero suicide as our improvement goal?” As a result HFHS developed the Perfect Depression Care model, a comprehensive approach that included suicide prevention as an explicit goal. Both best and promising practices in quality improvement and evidence-based care are applied in their model and they have had wonderful, life-affirming results—-an 80% reduction in the suicide rate among health plan members.

NAASP’s Clinical Care and Intervention Task Force then identified essential elements of suicide prevention for health care systems having a defined population of individuals with mental illness. The Zero Suicide approach is created around these essential elements.

Here’s what I like about their approach:

Zero Suicide asks for a change in culture with firm leadership buy-in. The workforce – this includes both clinical and non-clinical staff – is to be trained using the Zero Suicide Toolkit.  The cultural milieu is to foster a caring, non-judgmental workforce.  Considerate and compassionate caring has sometimes been absent when the person being cared for has attempted or considered suicide (c.f. The Way Forward report).  Suicide risk among people receiving care is identified and assessed systematically. Every person has a suicide care management plan, or pathway to care, that is timely and adequate to meet their needs.  Finally, I’m very encouraged that this planning includes collaborative safety planning and restriction of lethal means.

It is also vital that treatment address the person’s suicidality. The patient’s own suicide planning needs to be discussed in detail and taken apart and turned into a scenario where the person is once again safe. Contact and support for the suicidal person, especially when in transition between emergency room and home or inpatient care and home, must be continuous. Many suicides occur after discharge from the hospital or emergency room (c.f. The Way Forward and Continuity of Care for Suicide Prevention reports).  Deaths that occur after discharge aren’t inevitable; they can be tackled by better transition and discharge planning with greater attention to detail.

Fellow advocates, we can do better.  Zero Suicide’s program can help.

Eight Core Values

Writing again about new thinking emerging on suicide prevention – The Way Forward: Pathways to Hope, Recovery, and Wellness with Insights from the Lived Experience, 2014 .

There are eight core values The Way Forward’s Task Force agreed should be behind all activities designed to help attempt survivors, or anyone who has been suicidal:

  • Foster hope; help people find meaning and purpose in life
  • Preserve dignity; counter stigma, shame, and discrimination
  • Connect people to peer supports
  • Promote community connectedness
  • Engage and support family and friends
  • Respect and support cultural, ethnic, and/or spiritual beliefs and traditions
  • Promote choice and collaboration in care
  • Provide timely access to care and support

I deeply agree with these core values.

Fostering hope is the very first item. It must be so: Help finding hope can be a comfort, for even small hopes are so valuable. Let’s embrace interactions with the suicidal person that boasts their dignity, for chances are they have only a fragile self-respect — but all of us cling to our dignity. Connecting to peer support can be helpful; working with someone who has been there, knows what is what, someone who can be empathetic and a role model to boot. This is both wise and practical. Connecting to the community brings belonging, meaning and purpose from the community into the self. Thus respect and support for cultural, ethnic and/or spiritual beliefs is a fundamental good within human interaction. Promote choice and collaboration! Don’t we all need to have a say in our care, no matter the circumstance? Choice and collaboration gives us some respect and some feeling of effectiveness in our own care. Timely access to care. Indeed, when people have strokes or symptoms of heart attack, they expect fast, efficient life-saving care. The systems to provide that care exist in every little hamlet and metropolis. Surely we can create a system that continues care through and after a suicidal crisis, care that is intensive, smooth, protective and effective.


“For many years, suicide prevention has not engaged the perspectives of those who have lived through suicidal experiences,” declares The Way Forward.

Let me finish with a word about the two leaders behind this initiative.  They are, respectively, a survivor of suicide attempts and mental health advocate and, the other, a psychologist with years of experience working with people in suicidal crisis:  Eduardo Vega, MA, Executive Director, Mental Health Association of San Francisco and John Draper, PhD, Project Director, National Suicide Prevention Lifeline.

It is the hope of the Task Force and it’s co-leaders that The Way Forward will help bridge conversation about suicide prevention between mental health policy makers and consumer advocates. As a stimulating and thoughtful resource, it “…may enable these two powerful forces for change to come together and develop new, more effective approaches to reducing suicide attempts and deaths”.

Communities in Action to Prevent Suicide, part IV

Dr. Whiteside, concluding her keynote address to the Communities in Action to Prevent Suicide conference, April 2015, asked us to visit the websites below for a look at what suicide attempt survivors have to say for themselves.  Their words offer important insights. is a wonderful and compelling collection of portraits each linked to a suicide attempt survivor story, as told by those survivors. LiveThroughThis shows through these remarkable stories that everyone is susceptible to depression and suicidal thoughts. It does this simply by showing portraits and stories of attempt survivors — profoundly sharing that they are people no different than you or I.

As the website’s author Dese’Rae L. Stage writes, “…these feelings could affect your mom, your partner, or your brother, and the fear of talking about it can be a killer.”

The second website  is a now-completed project of the American Association of Suicidology. This site also features attempt survivors who have spoken up and told their stories. This website’s editor taught me a valuable lesson also. She wrote that people continually ask survivors about suicidal thoughts and actions, saying “Why would you want to do that to yourself?” As she noted, this question represents a shocking and a fundamental misunderstanding. You see, as when inquiring about any potentially fatal health issue the question needs only be, “Why is this happening to people we love?”

Do you see the stark difference between these two questions? The first, intentionally or not, is accusatory and focuses on blaming the suicidal person. The second question reflects concern for the person and asks why it is that this has happened to this individual, without seeing the act as a personal fault — and in truth, suicide is usually the result of a mental illness process.

Thank you for reading and for hearing and listening to them.

Communities in Action to Prevent Suicide, part III

A core value, again taken from The Way Forward, that Ursula Whiteside highlighted during her keynote:

Preserve dignity and counter negative stereotypes, shame, and discrimination

“The negative perceptions of behavioral health issues and subsequent discrimination pose major barriers to help-seeking.” …. “Stigma, negative stereotypes, and discrimination (covert or subtle) are particularly damaging when we already suffer from depression, hopelessness, damaged self-image, trauma, self-doubt, and shame – thoughts and feelings common during a suicidal crisis. In contrast, when we are treated with dignity and compassion, it reaffirms our sense of worth and value.”

My second psychiatrist (and each of those who followed) treated me with the dignity and compassion I needed to progress. It made a HUGE difference. One appointment I’ll never forget is the day I thanked him for NOT telling me ‘my difficulties’ were that I was ‘too sensitive’ (as I had been told by my first psychiatrist) . My doctor got very still, sat up straight, looked me in the eye, and said, “Gail, it’s not that you are too sensitive. You have major depression. It is an illness for which we will pursue and persist in finding the right treatment combination for you.”

He treated me with full dignity by clearing up any chance that I would misunderstand ‘sensitivity’ for major depression. Or think that ‘my difficulties’ were only that, ‘difficulties,’ and that they were something I caused. I felt affirmed and clear about the real lesson I was learning.

I particularly like this core value because it is so active…….counter stigma.

You can see from the photographs that Dr. Whiteside – Ursula – is younger than I. Her experience and youth were very helpful as I gained insight on how to reach to a younger public than I am used to addressing. She does social media very well; I need to go there too. The mid-part of her keynote presented her vision developing into an online public resource focusing on strategies for managing suicidal thoughts and intense emotions. Ursula introduced us to her colleagues: Team Now Matters Now. I smiled with pleasure as one of the team members mentioned was Marsha Linehan, PhD, clinical psychologist. Nothing more was said about team member Marsha … But it’s worth noting that Dr. Linehan is the creator of Dialectical Behavior Therapy, the psychotherapy that has helped so many people with borderline personality disorder. She is well known and admired for her work.

DrUrsulaWhiteside    DrMarshaLinehan

Ursula summarized what she and Team Now Matters Now had learned from suicidal people working through a crisis. Here are some of these points (underline emphasis is Ms. Whiteside’s):
Be fully present with me
• Help me hold my pain ( so I feel less alone in my pain)
• I feel helpless, broken and scared
• Discuss with me my diagnosis, as it is in the charts and go thru the DSM criteria with me
When including family and friends, tell me and let me decide who and how
Help me empower myself
• Gently examine my paranoid thoughts with me
• First I need empathy, a witness (rather than fixing)
Know that I am telling you about my suicide ideation/plans because I want to live, I want help and I want to work together

Communities in Action to Prevent Suicide, part II

Spring in Wisconsin has brought us needed and gently persistent rainfall. Nourishing rain on fertile ground; good food for our thoughts together.

Ursula’s keynote message, “…Zero Suicide and the Engagement of Those with Lived Experience” was a blend of her experiences working with others, and of new directions advocated in “The Way Forward: Pathways to Hope, Recovery, and Wellness with Insights from the Lived Experience, 2014”.

The Way Forward is the most readable, engaging, no-nonsense document that I have ever read. In fact, it is so good and there is so much to learn from it, that I read deeply through the report twice! It is a unique and creative look at suicide prevention. Prepared by the Suicide Attempt Survivors Task Force of the National Action Alliance for Suicide Prevention, the report’s recommendations are based on and prepared by people who have previously attempted to take their own life, and are now helping others in a crisis situation. Over the next days, I will highlight core values and recommendations from the report as presented in Ursula’s keynote. The first core value is:

Foster hope and help people find meaning and purpose in life

Pervasive hopelessness is a major risk factor for suicidal thinking and behavior. Studies have found that hope and optimism can help guard against suicide. From The Way Forward: “Hope is also linked to self-esteem and self-efficacy, as well as improved problem-solving. The pursuit of meaning can help a person cope with pain and suffering. Similarly, research on reasons for living has demonstrated that meaning and purpose are keys to recovery in many different groups of people who have lived through a suicidal crisis.”

I know this well. In my own suicidal crisis, I was saved by my husband who knew, somehow, that he had to teach me how to hope. (Please see Oh So Real: Pregnancy and Suicidal Depression) I had no hope for me or our unborn child, but I did have hope in our beautiful daughter who was about to turn 5 and start kindergarten in the fall…….when the baby was due. So Jim taught me to focus on specific events or achievements or activities of our daughter. One hope at a time, sometimes very small, got me through those difficult days and hope for her life certainly gave me a reason for living that had meaning and purpose. While the psychic pain of feeling suicidal is or can be overwhelming, meaning and purpose dull the pain…….take pain from the driver’s seat to the back seat.

It is possible to fuel a very small hope.

Communities in Action to Prevent Suicide, part I

Hello spring!  And hello during this National Mental Health Awareness Month.

Last Wednesday, April 29th, 2015, I attended the Communities in Action to Prevent Suicide conference put on by a growing organization I want you to know about, prevent suicide wisconsin, and Mental Health America, Wisconsin.

Reading the preconference materials, I was immediately attracted to one of the keynote speakers, Ursula Whiteside, PhD, a Clinical Psychologist from the University of Washington.  Ms. Whiteside is a member of the National Action Alliance for Suicide Prevention’s Zero Suicide Advisory Group.  The Action Alliance was launched by former U.S. Health and Human Services Secretary Kathleen Sebelius and former U.S. Defense Secretary Robert Gates to champion suicide prevention as a national priority. To quote from their literature, the Alliance champions “…a nation free from the tragic event of suicide.”

DrUrsulaWhitesideI wrote to Ursula before the conference, and to my delight she agreed to meet with me for a casual interview early in the morning, before her keynote. I greatly enjoyed meeting her, learned a lot, and am further encouraged.  She is a suicide attempt survivor herself and also knows and understands the Zero Suicide movement, an approach to suicide prevention that I’ll be discussing with you in my next post or two this week.

Stay tuned.

The Coming Days Emphasis ………… Suicide Prevention

Good day!   I officially launched my website and blog last Friday and Saturday at the NAMI (National Alliance on Mental Illness) Wisconsin Conference. So many friends and colleagues expressed interest and well wishes to me that I am more eager to write than ever.

I took yesterday off to spend an afternoon hiking the prairie and woodsy grounds of one of my favorite places, the International Crane Foundation (ICF) near Baraboo, WI. It was so serene and peaceful that I was able to see long and deep. Today I find my mind is free and my body is relaxed to think and write.

I will focus on prevention of suicide in my coming posts this spring. Particularly on advances in suicide prevention. Why? I believe suicide prevention should be a top priority for mental health organizations and concerned individuals, indefinitely. The US suicide rate is unchanged in 2 decades. Mortality from various medical causes has decreased (see charts below).
In hope of gathering current material on advances in suicide prevention, I am traveling to Stevens Point on Wednesday to attend another conference. The conference theme is “Communities in Action to Prevent Suicide” put on by Prevent Suicide, Wisconsin and sponsored by Mental Health America (MHA). There are two nationally known keynote speakers from the prevent suicide movement featured. I am eager to hear what they have to say and the advice they have to give.

I will couple the information from the Stevens Point conference with the conclusions and recommendations offered in the report The Way Forward: Pathways to hope, recovery, and wellness with insights from lived experience, National Action Alliance for Suicide Prevention: Suicide Attempt Survivors Task Force. (2014).  The report is available on my Resources On Suicide page. My hope is that you will feel better informed to look at suicide prevention practices in your area and seek input, if needed, and to update local policies and procedures to save more lives.


These graphs from a keynote presentation by Dr. Thomas Insel, Director of National Institute of Mental Health at the NAMI annual convention