February 9, 2016 Hosted by Public Health England

1. Zero Suicide:
How do we make a
long-term difference?
DAVID W. COVINGTON, LPC, MBA
CEO & PRESIDENT, RI INTERNATIONAL
PUBLIC HEALTH ENGLAND ZERO SUICIDE FORUM FEBRUARY 2016
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2. Big Hairy Audacious Goals
(BHAGs)
 Smallpox was eradicated in 1980.
 The five-year survival rates in 1975 of
certain forms of cancer, such as breast,
prostate, and colorectal, were 75%,
69%, and 51%, respectively. In 2007,
survival rates increased to 90%, 100%,
and 67%, respectively.
 And the incidence of polio has gone
down dramatically since 1988, when
over 350,000 cases were reported. In
2014, that number plummeted to only
359 reported cases, a 99% decrease.
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3. 6380 Computer/web services

4. Target Zero and Performance
Improvement
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5. Major Reductions
ZS Initiative Impact Status
US Air Force One-third reduction
over six years
1996 - 2002
Henry Ford Health
System
75% reduction in first
four years
2001 - Present
Magellan Health in
Arizona
38% reduction in first
two years
2009 - 2013
Centerstone 65% reduction in first
two years
2013 - 2016
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7. “[At the start] there was a lot of debate about whether or not it
was even possible to reduce suicide through this type of an
effort,” according to David Litts. “A lot of people, including
mental health practitioners, were skeptical. But over a six-year
period, the suicide rate dropped by one-third.”
US Air Force Initiative
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Prominent suicidologists, argued successfully, albeit
erroneously, that this is not a healthcare issue. They kept
suicide out of the mental health Bible, the DSM, stating,
“suicide is, by definition, not a disease, but a death that is
caused by a self-inflicted intentional action or behavior.”
Not a Healthcare Issue?

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Crossing the Quality Chasm
After becoming a finalist for a Robert Wood Johnson
Foundation grant, Don Berwick challenged the HFHS team to
pursue perfection. A nurse staff member suggested that would
mean zero suicide deaths. Within four years, their death rate
had decreased by 75 percent.

10. Prior to 2000, there was little research on crisis call center
effectiveness, and credibility was low. Since 2005, Link2Health
has dramatically increased calls and capacity, started a
Veteran’s hotline, added chat technology, and introduced
best practice standards now utilized worldwide.
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Standards, Training and Practices

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Reducing Both Death Rates and
Cost of Care
Arizona DHS and Magellan Health challenged the provider
network to eliminate health plan suicides. In 2011, Behavioral
Healthcare cited a 38% reduction in deaths, decreased
hospitalizations and dramatic increases in staff confidence.

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The National Action Alliance for
Suicide Prevention
In 2012, the US Surgeon General and the National Action
Alliance published a revised national strategy with new goals 8
and 9, calling for suicide prevention to become a “core
component” of health care, and for improved professional and
clinical practices, respectively.

13. In 2011, a task force of the National Action Alliance set out to
identify the best practice toolkit of interventions for clinical
care staff. The group was captivated by the cultural and system
changes of the pioneers below, and designed and published a
framework for replication.
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A Systems Framework

14. Between 1997 and 2006, mental health services implemented
recommendations to improve crisis and suicide care. While et
al concluded that implementing these recommendations was
associated with lower suicide rates in both cross-sectional and
before-and-after analyses. The provision of 24 hour crisis care
was associated with the biggest fall in suicide rates
14
While et al Study Evaluation Nine
Recommendations

15. The Substance Abuse and Mental Health Service
Administration (SAMHSA) funds the first cohort of 16
organizations and 48 leaders to develop implementation
plans. Faculty include champions from IFH, Centerstone
America and Group Health. The SPRC organizes and hosts the
event.
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Implementation Academies

16. The Suicide Prevention Resource Center develops a fidelity toolkit
and website to guide implementation, with seven key domains:
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Fidelity Toolkit

17. RFA-MH-16-800: Applied Research Toward Zero Suicide
Healthcare Systems (R01) - Applied research that advances the
Action Alliance's “Zero Suicide” goal for individuals receiving
treatment within health care systems, needed to implement
effective and comprehensive strategies in a variety of settings,
including behavioral health and substance abuse outpatient
clinics, Eds and crisis care programs and centers, hospitals, and
integrated primary care programs
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NIMH Research Grant

18. Leaders from New Zealand, the UK, the US and the
Netherlands met at IIMHL in Oxford, UK. Dutch psychiatrist Jan
Mokkenstorm: “We are at the beginning of this journey and
start out from the core value that not one of our patients
should die alone and in despair.”
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1st International Summit (Oxford
2014)

19. In September, a group of 50 service users from 13 countries,
healthcare providers and government policy makers convened
in Georgia. The International Initiative for Mental Health
Leadership match created an international consensus
document and plan for expanding the social movement.
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2nd International Summit (Atlanta
2015)

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21. In September, a group of 40 service users from 13 countries,
healthcare providers and government policy makers will
gather in Georgia. The International Initiative for Mental
Health Leadership match will create an international consensus
document and plan for expanding the social movement.
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3rd International Summit (Sydney
2017)

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Zerosuicide.org