Zero Suicide: Equipping Caregivers to Lead Our Patients Out of Crisis and Help Them Find Hope

January 14 2021
caring for one another

On a snowy February night in 2014, 20-year-old Emma Harmon tried to take her own life. She hadn’t been planning to, but the overwhelming feeling that she was out of her control led to a suicide attempt.

When she awoke in the hospital, she was angry that she hadn’t succeeded. The quick actions of a friend and her mother had saved her life.

In weeks and months that followed, Emma depended heavily on the support of friends and family as she sought healing. She began therapy with a new provider for her undiagnosed bipolar disorder, which had gone undiagnosed in her teen years. And the discovery that she was pregnant with her son, Kian, who is now 5 years old, gave her new purpose.

Her experience accessing behavioral health care, however, had been fraught. She had been told repeatedly to reach out for help over the years, and had tried many counselors, but had had trouble investing in her therapy. And when she found herself in the Emergency Department at Mercy Regional Medical Center on that cold night in 2014, in great pain as a result of her suicide attempt, instead of showing compassion for her mental health crisis, a nurse told her: “Maybe you’ll think twice next time you think about killing yourself.”

Responding to a crisis in mental health care
In 2018, 1,246 Coloradoans died by suicide – an alarming 56% increase in suicide rates over the past decade, placing Colorado sixth highest in the nation for completed suicides. At Centura, we believe even one life lost to suicide is too many, and we also know that as health care providers, we are in a unique position to help identify and support those experiencing mental health crises that can lead to suicidal thoughts. But as Emma’s experience demonstrates, suicide can be difficult to talk about – even for health care providers on the front lines of mental health crises.

To help reduce suicide rates in our communities, Centura Health is implementing Zero Suicide programming in partnership with the state of Colorado and Cardinal Health. Zero Suicide is a worldwide initiative designed to eliminate deaths by suicide by transforming health care and behavioral health care systems for suicidal patients. It aims to address systemic issues regarding caring for suicidal patients, including gaps in care, identifying suicidal patients, training needs for staff, and providing evidence-based care. It encompasses seven elements that are needed to create a care pathway for suicidal patients and their families, including:

  • Leading system-wide culture change committed to reducing suicides
  • Training a competent, confident and caring workforce
  • Identifying individuals with suicide risk via comprehensive screening and assessment
  • Engaging all individuals at-risk of suicide using a suicide care management plan
  • Treating suicidal thoughts and behaviors using evidence-based treatments
  • Transitioning individuals through care with warm hand-offs and supportive contacts
  • Improving policies and procedures through continuous quality improvement.

Health systems that have implemented the program have seen up to a 75% reduction in suicide rates among patients, and Colorado’s state suicide prevention plan is also modeled on the Zero Suicide protocol.

“Zero Suicide is an evidenced based model that provides us with the tools to implement changes to our health care systems, equipping our caregivers to lead individuals out of a suicidal crisis and help them find hope,” said Shannon McPherson, LCSW, Oncology Counselor and Zero Suicide Coordinator at St. Mary-Corwin. “This framework allows us to better deliver on our commitment to provide whole person care to those we serve. Together, we can help those who come to us in crisis know that there is hope and help available.”

Caregivers on a mission to achieve Zero Suicide
For some of the caregivers on the implementation team, this work is deeply personal. Shannon has specialized in the field of suicide assessment for the last 15 years, but her commitment to suicide prevention redoubled after the loss of her sister-in-law to suicide six years ago.

“The realities of mental health needs and suicide are a part of my daily work, but nothing prepared me for the sense of profound grief that my family and I experienced when we lost my sister-in-law,” said Shannon. “We will never know why she completed suicide, but we do know there was a complex myriad of risk factors, stressors and access to means that led to her death. I am honoring her memory by working on the Zero Suicide Initiative at St. Mary-Corwin and working in the community with the Pueblo County Suicide Prevention Coalition. Through these partnerships, we can provide hope to people like my sister-in-law and help them find a way to begin healing.”

Emma, too, has become involved in Zero Suicide efforts, serving on the Zero Suicide Implementation Team at Mercy Regional Medical Center to provide an invaluable patient perspective throughout implementation. Today, she is pursuing a degree in psychology and has become an advocate for behavioral health needs in her community. She has shared with Mercy caregivers that the feeling of judgement experienced during her time in the ED made her even more determined to kill herself and stresses the vital importance of showing compassion and empathy toward individuals with mental illness and patients who are suicidal.

“At the end of the day, a lot of people who consider or attempt suicide truly just want someone, anyone, who will sit by their side and just be with them through their pain and help them come out on the other side, together, safe and alive, hand in hand,” said Emma. “If we can take the sterile environment and response to suicide out of the picture and turn it into community care – that will change everything. And every single person plays a part in that. You can contribute by creating communities that truly care with the people around you – with your neighbors and co-workers, and also with people who are not like you, who may be misunderstood, underrepresented, or ignored. That is what will save lives. That is what will change the world.”

Through the Zero Suicide Project, our caregivers learn to help create those communities by providing appropriate, compassionate and effective support to individuals who are at risk of suicide, ensuring they are stabilized and receive the care they need in our facilities and beyond. Our comprehensive suicide care program begins with a patient’s first point of contact – whether that is in the Emergency Department, primary care, or other outpatient clinic – who ensure patients are screened, assessed, treated and followed up with in a way that improves their individual success and maintains their safety.

Studies have shown that the risk of suicide increases to 70% when systems of care are fragmented. However, Centura is committed to providing the right referral to the right patient at the right time and began a patient follow-up program in June 2020. Our caregivers collaborate with community partners like Rocky Mountain Crisis Partners and Axis Health System, Mercy’s behavioral health partner, to target suicide risk and ensure our patients don’t fall through the cracks when transitioned between our agencies, inpatient psychiatric facilities and the community.

You can learn more about the framework and implementation of Zero Suicide here.

You matter. You are not alone. Help is available.

  • Colorado Crisis Line: 1-844-493-8255 or text TALK to 38255
  • National Suicide Prevention Lifeline: 1-800-273-TALK
  • Not comfortable talking on the phone? Text NAMI to 741-741
  • For local and regional suicide hotlines in Kansas, visit Suicide.org
  • Centura associates: Resources are available, visit Profile EAP or call Profile EAP at 800-645-6571