Improving Care to Prevent Suicide Among People with Serious Mental Illness Proceedings of a Workshop (2019) / Chapter Skim
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3 Suicide Prevention in Health Care Systems
3 Suicide Prevention in Health Care Systems
Pages 29-44
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From page 29... ...
(Hogan) • The Perfect Depression Care Initiative and its goal of zero suicide dramatically reduced suicide rates at the Henry Ford Health System and provided a proof-of-concept model that other systems have adopted.
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These initiatives point toward the possibility of making much more extensive changes in health care systems, both in the United States and abroad, that could achieve for suicide prevention the successes achieved through prevention initiatives targeting health issues such as smoking or heart disease. THE ORIGIN OF THE ZERO SUICIDE MODEL In 2001 the Institute of Medicine (IOM)
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Using the IOM report as a guide, the foundation sought applications for transformative plans to create health care systems that would approach ideal care within a timeframe of 2 years. From about 300 applications submitted in 2001, 12 finalists were selected, including the Perfect Depression Care Initiative proposed by the Behavioral Health Services Division of Henry Ford Health System in etroit, Michigan.
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From page 32... ...
However, after implementation of the Perfect Depression Care Initiative, the suicide rate for patients receiving mental health care in the Henry Ford Health System dropped by more than 75 percent, though the rate rose again in 2010 when the recession that began in 2008 was especially severe in Michigan (Coffey et al., 2015)
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In 2012 the Perfect Depression Care Initiative was invited by Mike Hogan and David Covington to partner with the National Action Alliance for Suicide Prevention, a partnership which has yielded a "hugely productive" collaboration that has embraced the goal of Zero Suicide (see the following section of this chapter)
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DISSEMINATION AND EVIDENCE FOR ZERO SUICIDE Even as the suicide rate has increased in the past 15 years, the age- adjusted death rates for heart disease, cancer, and stroke have fallen. Why has prevention for other causes of death been successful while suicide prevention has not been successful, asked Mike Hogan of Hogan Health Solutions.
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It combines a quality improvement with a bundling of care, as has been the case with innovations applied to other health conditions. This point is made in the report Suicide Care in Systems Framework (Clinical Care and Intervention Task Force and National Action Alliance for Suicide Prevention, 2011)
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(2013) study, prediction of who needs suicide prevention are much better then high cholesterol scores are to predict a heart attack, Hogan said.
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The idea of d irectly treating suicidality is "fundamentally relevant" to the workshop, he observed. "If somebody is suicidal and has a major mental illness, it's no longer acceptable to just treat the major mental illness and hope that the suicidality resolves." The critical issue, said Hogan, is that the usual care for people at risk of suicide is unacceptably bad -- "people are dying." Importantly, this is not because of clinician error but because health care programs and systems have not put proven methods in place, leaving clinicians to manage care on their own.
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Though the United States is still making progress on early intervention programs, the time to treatment after a first episode of psychosis in the United Kingdom has been slashed to a target of 22 days, "in large part because of an audacious vision and a pathway for beginning to make that happen." The 2011 report Suicide Care in Systems Framework (Clinical Care and Intervention Task Force and National Action Alliance for Suicide Prevention, 2011) could have gathered dust on a shelf, said Covington.
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The suicide prevention activities that need to be done are not complicated, he added, but they have previously been out of scope and health care professionals, including behavioral health professionals, have not received training on them. Finally, ways need to be found to get reimbursement for these activities, Hogan said.
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. Instead cut back on that and devote the resources to safety planning and getting much better at means restriction." RESISTANCE TO THE IDEA OF A ZERO SUICIDE GOAL Nadine Kaslow, professor of psychiatry and behavioral sciences at the Emory University School of Medicine, asked about the unanticipated consequences of zero suicide initiatives.
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At the same time, behavioral health treatment within the health care system takes place in many contexts other than zero suicide programs, and these other contexts may have implications for preventing suicide among those with serious mental illness. "Should we be looking for ways to insert suicide prevention into those initiatives that are going to continue with or without suicide prevention?
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Hogan responded with an anecdote about a Zero Suicide training boot camp, which they call Zero Suicide academies. One of the people attending the training was an internist in a small practice who seemingly would not need to know this level of detail about suicide prevention.
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2007. Building a system of perfect depression care in behavioral health.
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