“Has anyone here lost a patient to suicide?” Dr. C. Edward Coffey asked the audience at the Zero Suicide conference in the Sheraton Hotel on Tuesday.
About a third of the audience of behavioral health care professionals, including doctors, staff, community workers, clinicians and social workers, raised their hands.
Coffey, keynote speaker for the event and CEO of the Menninger Clinic in Houston, Texas, noted that suicide rates in Wisconsin and across the nation have been increasing in recent years. Over 40,000 Americans commit suicide every year.
“We’ve tried different things, and it doesn’t seem to be working. The numbers are the same. We need to try something new,” he said.
Coffey, a leader of the Zero Suicide movement, was the first speaker at a two-day conference aiming to teach the community a new approach suicide prevention. The name of the movement reflects the goal — to lower the number of suicides to zero. The initiative believes that every suicide is preventable, and emphasizes dramatic change within health care systems.
“We end up talking ourselves into these incremental changes and we don’t stretch ourselves,” Coffey said. “Nibbling at the edges isn’t going to fix it. We’ve got to blow up and start over.”
Zero Suicide, a national initiative from the Suicide Prevention Resource Center, is a system-wide quality improvement program that aims to ensure that those at risk for suicide do not go untreated or uncared for. It calls for comprehensive treatment — addressing more than depression — and enlisting the help of the broader community. The conference focused on the core concepts, benefits and practices needed to begin to implement Zero Suicide in health care and community organizations.
Coffey was previously the vice president of the Henry Ford Health System, where the program that would eventually become known as Zero Suicide was first started.
It initially received push back and criticism from suicide experts, who believed the goal set up the organization for embarrassing failure. There is a prevailing attitude in the medical community that if someone really wants to commit suicide, they cannot be stopped, Coffey said.
“I was trained that suicide was an inevitable outcome of some diagnoses,” Coffey said.
Nevertheless, the organization pursued perfection, defined as zero suicides. Coffey said that if even a 99.9% accuracy rate was considered good enough in other fields, 12 babies would be given to the wrong parents, two million records would be lost by the IRS every year. The accuracy rate in medicine is between 60 and 80 percent, he said.
The Behavioral Health Services division of Henry Ford overhauled its system, receiving feedback from patients, improving timely access to care and mandating department-wide certification in cognitive behavior therapy.
Coffey also emphasized the importance of restricting means to suicide. At Henry Ford, it became policy to have a conversation with the patient and their family asking the patient if and how they had visualized themselves committing suicide. The family and patient were then instructed to remove the means. This often resulted in a firearm being removed from the home, which was a surprisingly effective deterrent, Coffey said.
As a result of their efforts, Henry Ford saw an 80 percent reduction in suicides over ten years, and experienced one year of no suicides.
The conference was hosted by Safe Communities of Madison-Dane County and UnityPoint Health-Meriter, groups working to adopt Zero Suicide practices in Wisconsin. In 2015, Meriter began implementing this system in its emergency room and inpatient psychiatric units.
Sue Janty, director of behavioral services at UnityPoint Health, was originally overwhelmed with the idea of organizing a system-wide change, thinking “I don’t know how I can do this.” Eventually, she came to realize the program was so important that she thought, “I don’t know how I can’t do this.”
At Meriter, key points of the program include creating a safety plan, a conversation about removing means to suicide and setting up an outpatient appointment before hospital release for any at-risk patients. Meriter also makes a follow-up call within 72 hours of release. So far, 1,300 individuals have received these services.
Janty is enthusiastic about Meriter’s progress, but wants to see the broader community engage in these efforts as well. From 2009 to 2013, 40 percent of individuals in Dane County committed suicide with a firearm, according to the Public Health Department of Madison and Dane County, and Janty believes many organizations can help prevent access to firearms or other means of suicide.
Speakers and panels also addressed topics like how to put the Zero Suicide program into practice and address any challenges that arise.
Coffey ended his talk by emphasizing the need to take action, reminding the audience that while perfection is the goal, they should not be unduly discouraged by mistakes.
“We’re asking people to swing for the fence every time they go up to bat. Sometimes we’ll strike out, but we have to learn when we strike out,” Coffey said. “Errors are going to happen, but what we don’t tolerate is making the same mistakes over and over again.”