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.

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 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.

Resources on Suicide – and the way forward

I’ve written a resource page on Suicide – Look on the menu bar, click Suicide and then Resources on Suicide.  There are links there for anyone who may be at risk for suicide or is a survivor of a suicide attempt.  I hope they can be of help for you.

Especially I want to draw attention to the link for the report The Way Forward: Pathways to hope, recovery and wellness with insights from lived experience (2014 pdf), by the National Action Alliance for Suicide Prevention’s Suicide Attempt Survivors Task force.   The report is unique in its breath and scope, and unique in that its co-leads were one, a survivor of suicide attempts and mental health advocate, and the other, a psychologist with years of experience working with people in suicidal crisis.

“For far too many years suicide prevention has not engaged the perspectives of those who have lived through suicidal experiences. Because of social stigma and fear, as well as personal shame, a culture of silence prevailed. The Way Forward represents a seminal moment in this field’s history; it is an opportunity to benefit from the lived experience of suicide attempt survivors. Many of its recommendations are derived from evidence-based practices, and several are aspirational. All are grounded in the evidence of recovery and resiliency that is clear in the lives of our Task Force members.”
– from the report.

Oh So Real: Pregnancy and Suicidal Depression

“Oh baby,” I said, as he/she came down the birth canal, “You are born!”. It was 1979. We didn’t know the sex of the child before birth. The birthing experience was wonderful, a balm for the difficult pregnancy caused by the onset of major depression in the fourth month of pregnancy.

I was alone.

Don’t get me wrong, my husband was with me very much during the pregnancy. But I was alone with being pregnant and being ill. I knew no other woman who was or had been pregnant and seriously depressed to talk to, to compare notes, to help me express my feelings or to hug. I hope this summary of my story of the difficult pregnancy will help other mothers who find themselves struggling with similar experiences today.

If you are pregnant and depressed, you are Not alone.