Patients who were seen at outpatient mental health clinics were significantly less likely to attempt suicide when clinics practiced “Zero Suicide” principles, including suicide screening, safety planning, and support during care transitions with follow-up after discharge from acute care settings. These findings were published Thursday in a report in Psychiatric Services in Advance.
Zero Suicide principles grew out of a 2012 partnership between the Office of the Surgeon General and the National Action Alliance for Suicide Prevention (NAASP). The NAASP Clinical Care and Intervention Taskforce developed a set of organizational best practices aimed at eliminating suicide and targeted specifically at health care settings. The Psychiatric Services study is the first to show that when mental health clinics abide by these principles, the risk of suicide among patients is significantly diminished.
Deborah M. Layman, M.A., of the New York State Office of Mental Health and colleagues surveyed 110 outpatient mental health clinics in New York state for their “fidelity” to 17 Zero Suicide’s organizational practices (meaning how closely they abided by the practices) using the Zero Suicide Organizational Self-Study questionnaire. Responses to the 17 items were averaged to compute a total Zero Suicide fidelity score for each clinic. Data on suicidal behaviors—specifically, suicide attempts and deaths—were extracted from the New York State Incident Management Reporting System.
The researchers found that the higher the fidelity to the Zero Suicide organizational practices, the less likely clinics were to have suicidal attempts or deaths among their patients. Moreover, there was a statistically significant difference in total fidelity scores between clinics with and without a suicide incident in the previous year.
Two practices had the highest effect on reducing the risk of suicide among patients:
- Suicide-specific quality improvement activities, which the authors defined as “having suicide care embedded in the medical chart, written clinical workflows for suicide care, and data collection and review by clinical teams.”
- Lethal means reduction, or working to ensure patients are safe from the means for suicide at home. The authors noted that lethal means reduction “requires documentation in safety plans as a standard practice” as well as “policies addressing clinician training, family inclusion in means reduction, and confirmation of means reduction.”
Five other practices were also found to be crucial: commitment of clinic leadership to suicide prevention, assessments of confidence in suicide care and of skills among staff, suicide risk assessments, engaging hard-to-reach and no-show patients, and following up with patients who were discharged from acute settings.
“Clinic engagement in suicide-specific quality improvement activities and in strategic development of effective policy- and protocol-based lethal means reduction may be particularly important for reducing suicide risk,” the researchers wrote.
For related information, see the Psychiatric News article “Upping Our Game to Prevent Suicide.”
(Image: iStock/robypangy)
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