Implement Best Practices for Prevention in Health Care Systems
Promote a systematic “Zero Suicide” approach, rooted in the understanding that suicide is preventable in people receiving treatment services.
- Zero Suicide: The Zero Suicide framework is a systemwide, organizational commitment to safer suicide care in health and behavioral health care systems.
- Suicide Prevention Resource Center (SPRC): SPRC is the federally supported national resource center devoted to advancing suicide prevention infrastructure and capacity building through consultation, training, and the provision of information, resources, and tools in support of suicide prevention efforts.
The Zero Suicide Framework
The Zero Suicide framework is grounded in the most current, systematic, and evidence-based research in suicide prevention. Core concepts include:
- Zero suicide deaths— If zero isn’t the right number, what is? In trying to determine an “acceptable” number of suicide deaths, you reach the conclusion that zero deaths is a hopeful and aspirational goal.
- Paradigm shift— A fundamental shift away from accepting suicide as an occasional consequence of mental illness to an understanding that suicide is preventable.
- Systems approach— A focus on systemwide quality improvement rather than blame when suicide attempts and deaths do occur.
- Quality improvement— An emphasis on improving systems and developing systemwide policies and procedures instead of relying solely on the efforts of individuals.
- Health systems commitment— Zero Suicide provides an aspirational challenge and practical framework for systemwide transformation in health care systems toward safer suicide care.
Voices From the Field
"Involving people with lived experience is important because they may have a different outlook because they have first-hand experience of what it is like to struggle through mental illness or loss from suicide. They can speak the same language as someone that has been through similar struggles. "
– Patty Slatter, NAMI Rock County, Person with Lived Experience
With the knowledge that suicide deaths can be prevented for individuals receiving care in health and behavioral health systems, suicide prevention is increasingly being seen as a core responsibility of health care. This culture shift is the foundation of the continuous quality improvement model called Zero Suicide. The Zero Suicide framework is based on a systematic approach to quality improvement; it does not rely on the heroic efforts of individual clinicians but rather the conscientious and consistent use of specific tools and strategies throughout organizations. Just as health systems have been able to initiate systematic practices and policies to eliminate medical errors and falls, the Zero Suicide framework can reduce and has reduced suicide by individuals receiving care, with the aspirational goal of reducing the number of suicides to zero.
Toward Zero Suicide in Wisconsin
- Across health and behavioral health care settings, there are many opportunities to identify and provide care to those at risk for suicide.
- The Zero Suicide framework is a systemwide, organizational commitment to safer suicide care in health and behavioral health care systems.
- 83% of those who die by suicide have seen a health care provider in the year before their death.21
- To assist health and behavioral health organizations adopt the Zero Suicide framework, the Suicide Prevention Resource Center offers a free and publicly available online toolkit that includes modules and resources to address each of the seven elements of Zero Suicide. The toolkit is available at: https://zerosuicide.sprc.org/toolkit.
Voices From the Field
"From a project management standpoint, an organization cannot embark on this important work without a solid implementation plan. The Zero Suicide framework at zerosuicide.org sets the foundation to implement and sustain all seven components. Advocate Aurora Health is expanding the success of Zero Suicide from Aurora Sheboygan Memorial Medical Center to the entire enterprise—from Wisconsin to Illinois. "
– Becky Babcock, Performance Advisory Consultant, Advocate Aurora Health, Sheboygan
Another key aspect of this quality improvement framework is engaging people with lived experience of suicide (suicidal thoughts and behaviors or suicide loss). For an organization’s Zero Suicide implementation plan, one of the goals should be to have an implementation team that includes people with lived experience in developing, implementing, and evaluating efforts. A report from the National Action Alliance, The Way Forward: Pathways to Hope, Recovery, and Wellness with Insights from Lived Experience, offers a set of core values to inform suicide prevention and care, as well as specific recommendations for health and behavioral health care organizations and program developers.22
The Seven Elements of Zero Suicide
1. Lead systemwide culture change aimed at suicide prevention.
2. Train a competent and caring workforce.
3. Identify patients with suicide risk via comprehensive screening.
4. Engage those at risk using a suicide care management plan.
5. Treat those at risk with evidence-based treatments.
6. Transition patients through levels of care with warm hand-offs.
7. Improve systems using data for continuous improvement.
3A: Promote a systems change approach