Project Zero Suicide in Health Care 2013 10
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Zero Suicide in Health Care: Not Another Life to Lose
DAVID COVINGTON, LPC, MBA—CRISIS ACCESS, LLC
crisisaccess.com
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Looking at Suicide Differently
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Polling Question #1Someone who died by hanging with their hands bound behind their back and feet tied together was probably a murder, not a suicide.
A. TrueB. False
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The Forgotten Patient
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572,000Hospitalizations**
752,000 AttemptsRequiring Medical Attention**
1,100,000Suicide Attempts**
8,700,000 Seriously Considered Suicide**
38,364 Suicides*
Source: * National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. (2009). Web-based Injury Statistics Query and Reporting System (WISQARS). Available from: www.cdc.gov/injury/wisqars/index.html.**Substance Abuse and Mental Health Services Administration, Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-42, HHS Publication No. (SMA) 11-4667. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.
Pyramid of Suicidal Behaviors
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6.8 to 10.5
10.6 to 13.9
14 to 16.9
17 to 23
23.2
17.1
14.0
14.5
10.6
13.9
16.9
10.5 6.8
Suicide Rates (2010 National Average Rate 12.4)
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0
5
10
15
20
25
30
35
40
45
50
5-9 10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Rat
e/10
0,00
0
Age Group (Years)
White Male AI/AN Male Black Male
White Female AI/AN Female Black Female
Source: National Center for Health Statistics. Note: Non-Hispanic Ethnicity
Suicide Rates by Age, Race, & Gender
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What Have We Learned Over the Past Decade
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Polling Question #2Suicide Can Be Prevented.
A. Never in Those Truly Intent on Suicide
B. Sometimes, but Only in Advance of Acute Risk
C. Always, but Only in Advance of Acute Risk
D. Always, Even Up to the Last Moment
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1978
1990
2003200520062010
1975
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1978
1990
2003200520062010
1975
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1978
1990
2003200520062010
1975
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1978
1990
2003200520062010
1975
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1978
1990
2003200520062010
1975
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1978
1990
2003200520062010
1975
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Suicide Attempts: • Female>>male• Rates peak in adolescence• Concern: Latina youth and LGBT
Suicide Deaths: • Male : female = 4:1• Elderly white males • Working aged males (60%)
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Group A Group B
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Diagnosis is Not Destiny: Survivors Survive!
Ambivalence is Universal
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Polling Question #3Suicide is (mark all that apply):
A. A ChoiceB. A Sign of Psychological WeaknessC. Akin to Murder (Only of the Self)D. Akin to CancerE. All of the Above
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Suicide is Not a Choice
Rabbi Kushner’s Reference to Ice Endurance
Experiments
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Survival is In Our Cells & Souls
Death by suicide fearsome and daunting prospect.
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What are the Implications for Health Systems?
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Polling Question #4The risk of death by suicide for those with Serious Mental Illness is how much greater than the general population?
A. The Same RateB. Two Times GreaterC. Four Times GreaterD. Six to Twelve Times Greater
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“Over the decades, individual [mental health]
clinicians have made heroic efforts to save lives… but systems of care have done very
little.”
Richard McKeon, SAMHSA
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“Suicide represents a worst case failure in mental
health care. We must work to make it a ‘never event’
in our programs and systems of care.”
Mike Hogan, Former State MH
Commissioner
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What Inspired Zero Suicide?
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The Air Force Did It
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Henry Ford Also Did It
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What Does It Look Like to Make Suicide Care Core Business?
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From: To:Training and tools Systems & culture changeIndividual provider actions; suicide care as “specialty”
Suicide prevention woven into all aspects of care; everyone’s job
Episodes of crisis Continuity of care
Suicide Care in System Framework
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• Joint Commission National Patient Safety Goal
• Veteran’s Administration Training, Surveillance and Enhanced Care
• NSPL Standards and Guidelines
Lots of Groups Are Making Progress
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alternatives to hospitalization based
on trusting therapeutic relationships
alternatives to ER such as same-day scheduling for MH services and in-
home crisis care
immediate and continuous follow-up after ER or Inpatient
discharge
Educate family members and
significant others
What Can You Do to Help Implement the National Strategy?
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Case Study Phoenix: TERROS
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One of a dozen founding organizations of the AZ programmatic suicide
deterrent system in 2009.
TERROS, Phoenix, Arizona
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Clinicians/Social Workers
35%
Case Managers
30%
Physicians/ Nurses
3%
Admin &Non-clinical
26%
Certified Peer Staff
6%
PC
Workforce Composition
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11% of Agency Staff Report Specific Suicide Care Training (ASIST)
57%
18%
25%
None One Two or More
Suicide deaths
reported by clinicians
PC
2009 Survey
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81% of Agency Staff Report Specific Suicide Care Training (ASIST)
PC
2012 Survey
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Agree or Greater x3 Don't Know/ Mixed Disagree or Greater x3
36% 37%
27%
86%
12%
2%
2009 - Non-ASIST 2012 - ASIST
1) Training 2) Skills 3) Supervision/Support
Comparing Two Cultures
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How to Become Suicide Safer Care Center
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Learning Collaborative, Julie Goldstein-Grumet
Learning Collaborative, Meena Dayak
ZS Advisory Board (Mike Hogan & David Covington Co-leads)
3,802
2,507
1,123
6,2921,562
6,816
771
6588,344
National Survey of 30,000 MH Professionals Across Nine States
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Role #Counselor 2,421Social Worker 2,361Physician 416Nurse 1,371Case Manager 3,312Para-professionals 826Certified Peer Staff 479Administrator 2,640Support Staff 3,409
Skills
39%
Trai
ni
ng
44%
Supports
30%
One/Three
53%
Endorsed Don’t Know, Disagree, or Completely Disagree
I have the _________ to engage and assist those who are suicidal.
•3,314 / 15%Once
•2,792 / 13%More than once
Over 6,000 report a patient has died by suicide (27%).
1x2x3x4x6x
4%24%
38%23%
12%
SMI Suicide Rate vs. General Population
The Survey Results
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Skills
57%
Trai
ni
ng
48%
Supports
31%
One/Three
63%
Endorsed Don’t Know, Disagree, or Completely Disagree
I have the _________ to engage and assist those who are suicidal.
Without Specific Suicide Training
1,407
Skills
8%
Trai
ni
ng
6%
Supports
10%
One/Three
15%
Endorsed Don’t Know, Disagree, or Completely Disagree
I have the _________ to engage and assist those who are suicidal.
ASIST Trained
1,324
ClinicianPhysician/Nurse
Certified Peer StaffAdministrator
Case ManagerSupport Staff
Overall
33%
37%
62%
66%
70%
80%
63%
15%
10%
9%
12%
17%
18%
15%
ASIST TrainedNo Suicide TrainingO
ne/T
hree
Two Day ASIST Training
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zerosuicide.com
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“Suicide prevention has not been informed by peers who have experienced the agony and decision-making. They
can provide support that can be magic”
Eduardo Vega, MHA of San Francisco
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Contact Us Zero Suicide Advisory Group Co-Leads [email protected] [email protected]
Social Networking http://www.linkedin.com/in/davidwcovington https://twitter.com/davidwcovington https://www.facebook.com/david.covington http://www.youtube.com/davidcovington
crisisaccess.com