Let’s dream for a moment. It’s early 2016 and the Get Ready for Hillary campaign is storming the country. In a press conference, her running mate announces a bold and innovative healthcare initiative that will comprise an important component of the Clinton platform. It’s a call for Zero Suicide, a pledge to replicate the success of Dr. Ed Coffey’s team at the Henry Ford Health System in Detroit, Michigan. Innovative pilots in Arizona, New York, Texas, and Tennessee are cited. Within days, the Secretary of Health and Human Services echoes support and outlines a plan to implement the evidence-informed approach across the country.
CNN, USA Today, and the New York Times all feature the story repeatedly. There are no headlines that call the notion naïve or misguided. Instead, there is a rich, informed, and productive debate about the adequacy of the US healthcare system and its behavioral health capacity, and the way forward to bring a central focus to suicide care. Millions engage in the public media discussion of challenges, e.g., the difference in male and female suicide rates. The American Association of Suicidology creates a dedicated website in support of the initiative and publically calls for better training and systems for behavioral health professionals.
Since 2010 and the formation of the public/private partnership that is the Action Alliance for Suicide Prevention, we have seen a top level U.S. government focus that is unprecedented. Instead of the hundreds that previously focused on this work, we have seen thousands become engaged. Yet, suicide is a challenge that requires the attention of millions, and that’s a level of engagement that has been restricted to other pressing issues; heart disease, cancer, HIV/AIDS, traffic and airline accidents, etc.
But not suicide.
So yes, as recently as the close of 2014, the scenario above would have seemed very farfetched, if not impossible. And yet, this is exactly what occurred last month… in the United Kingdom.
With general elections in May, the race is entering the homestretch in England. January 18 was to be a day of dueling mental health initiatives, with the Labour party suggesting more funds be allocated to child services.
UK Deputy Prime Minister Nick Clegg appeared on a BBC talk show to provide the Liberal Democrats counter, and promised to sign up the National Health Service (NHS) for a country-wide “Zero Suicide” campaign. He referenced pilot programs in organizations in Merseyside, the east of England, and the southwest that have employed the Henry Ford Health System model “where suicides were sharply reduced from 89 per 100,000 in 2001 to as low as zero among the patient population over the decade” (Guardian, “Lib Dems announce campaign for NHS to set ‘zero suicide’ goal”).
Clegg called for charities, voluntary organizations, and the NHS in “every part of England” to join in the effort to eliminate suicides. And Clegg encouraged a no-blame approach to the effort, mirroring the “just culture” performance improvement approach espoused by Dr. Ed Coffey, the pioneer behind the success at Henry Ford. “[Zero Suicide] is doing more in every area of our society to ensure that people don’t get to that point where they believe taking their own life is their only option,” said the Deputy Prime Minister.
Several pilot programs, which have already embarked on the mission, were mentioned, including:
- Project Zero in southwest England. This program includes individuals with lived experience in its steering committee and partners behavioral health and social service organizations with local emergency services to identify and support individuals at risk, including utilization of Jeffrey Brenner’s “hot spotting” techniques.
- Mersey Care. An NHS trust in Liverpool, this program has established a goal to eliminate suicides in its area by April 2018, with training for staff in the skills to support those at risk, such as safety planning. They have also engaged a tiger team for monitoring individuals at highest risk.
- Stop Suicide Campaign. This program in Eastern England’s Cambridgeshire and Peterborough is providing ASIST (Applied Suicide Intervention Skills Training), and using social media and community events with public pledges.
Two days later, Norman Lamb, the UK’s Minister of State at the Department of Health, wrote about breaking the taboo on the last stigma, mental health and suicide. “We want to see this sort of approach [Zero Suicide] taken across the country.” (Read the Letter.)
After these events, the dialogue exploded and it was rich.
The BBC featured an article, “New strategy to cut suicides ‘achievable’, says Clegg.” The Guardian reported “Zero suicides is an admirable aim but it requires all-out change.” It also addressed the disparity between male and female suicide rates (read here). Allied non-profit organizations like the Samaritans and Contact NI weighed in with support. Professional associations immediately took notice, with NursingTimes.net addressing “‘Zero suicide’s goal risks blame culture if applied ‘clumsily.’” The Telegraph argued the first step in the ambitious plan would be to reject euthanasia and “assisted dying.”
Twitter traffic soared on the topic of Zero Suicide in the 30 days since Clegg’s proclamation.
Just yesterday, in an article on the suicide deaths of adults detained while in psychiatric inpatient, jail or prison, the BBC reported the Department of Health for England is calling on every part of the NHS to commit to a new “zero suicide” ambition, again referencing the “perfect depression care” program at Henry Ford.
It’s a dream come true to see the political will at play in the UK in the spring of 2015. However, some might be concerned about the translation 4,000 miles away on the other side of the pond. As the mission spreads, will there be fidelity to the model?
The catalyst for success at Henry Ford was inspired in large measure by Don Berwick and the Institute for Healthcare Improvement, authors of Crossing the Quality Chasm and the 100,000 lives campaign for increased patient safety in hospitals. Studying these efforts yields four essential bold ideas, and they were all front and center in the January dialogue in the UK.
What distinguishes a Zero Suicide initiative?
- First, the goal of Zero Suicide must emanate from the leader. When it’s the stated objective of the CEO, Health Commissioner, or Deputy Prime Minister Clegg, one can be confident the resources of the full enterprise will follow (Bold Idea #1).
- Second, Zero Suicide starts the goal from the other end. It was clear from their language that Clegg and Lamb eschew the potential for incremental change in favor of a bold declaration (Bold Idea #2).
- Third, Zero Suicide includes individuals with lived experience in the leadership and design (Bold Idea #3).
- Finally, Zero Suicide reject the myths. It believes suicide is not inevitable; not a choice. Aspire for Zero (Bold Idea #4).
As Minister of State Lamb stated, “Different regions will find different ways of targeting ‘zero suicides’… But as much as anything else, we need a change of mindset in our health system and in our society to understand that suicide is something that we can prevent and that we can talk about openly without shame.”
That’s a great vision for the Zero Suicide in Healthcare mission… not just in the United Kingdom, but for the world.
*Note: David Covington co-authored this blog with Fergus Cumiskey, the Managing Director with Contact, Northern Ireland, which operates the regional crisis counseling service and 24/7 crisis helpline, under license from the Public Health Agency.