3 reflections from the 2018 Zero Suicide International summit

CARF Managing Director Michael Johnson traveled to the Netherlands earlier this month to network with the top suicide-prevention experts in the world. Here are his thoughts.

By Michael Johnson, managing director of behavioral health, CARF International

The Zero Suicide Initiative is a key piece of the National Strategy for Suicide Prevention, a project of the National Action Alliance for Suicide Prevention. It is based on the belief that suicide deaths of people receiving care in health and behavioral health systems are 100 percent preventable.

Suicide is a major public health crisis that demands a well-rounded public health response. We know a large percentage of people who attempt suicide had previously interacted with the healthcare system. We have an opportunity and responsibility within the industry to create a better system of training, intervention, screenings, and more to eliminate this crisis.

I attended the Zero Suicide International Summit this year to exchange ideas with global thought leaders on how to accomplish this. I came away with many thoughts, but here are some of the highlights:

1. The “Zero Suicide” goal can make people uncomfortable

   I was surprised at how much conversation centered on the question, “Is zero really the right number?” We spent a lot of time discussing whether better systems and practices could realistically eliminate suicide completely.
   
   Is zero suicide actually achievable?
   
   As a unit of measure, it doesn’t matter. I don’t think we should aim for any other number. It would not matter to the family who lost a brother, or mother, or son to suicide to be told we reduced suicide by 10, 50, or even 80 percent. We should not be focused on the number, we should be focused on patient safety.
   
   I understand the practicality of the question. But zero is meant to be aspirational. There is no acceptable number of suicides, no number at which we should be satisfied. No one should die alone and in despair, especially if we know it is preventable each and every time. Getting hung up on zero only takes time away from more helpful messaging.

2. We need to support the mental health of clinical staff

   There was a terrific presentation by two psychiatrists from a Malaysian healthcare facility. They each shared their stories of a patient who died by suicide. The presentation focused on the impact the death had on clinical staff and caregivers.
   
   At the time of the patient’s death, the organization did not have any policies or supervision plans in place to provide emotional support for its staff. This is an important topic because, often, a hidden dynamic in the discussion of suicide is the grief, self-doubt, and trauma experienced by the healthcare professionals who had interacted with a person who died.
   
   Like any other situation where someone experiences death and loss, we need to have systems in place to provide support. But beyond the basic human aspect, this problem presents a challenge for our industry in providing quality services. Grief leads to burnout, which leads to high turnover rates. Further, without reasonable support systems, caregivers may avoid high-risk patients altogether, leading to fewer supports for patients. This is a bad cycle.
   
   As caring organizations, we have a responsibility to reach out to our own personnel. This is a practice that seems natural to expand on within CARF’s standards. I think we need to consider this in future standards updates.

3. The U.S. can learn from international prevention efforts

   The summit featured expert representatives from 20 different countries. The idea is that we should learn from one another and spread best practices. With this in mind, I believe the U.S. can take some great lessons in how to approach the issue of suicide from a public health perspective.
   
   Many countries have higher-visibility public health campaigns than the U.S. Television spots, billboards, and advertisements target the general public to try and break down the stigma of talking about suicide. It should be more obvious to people in the general public what they should and can do. These campaigns provide motivation to talk with someone who may be in pain, educate how to react and offer support, and direct whom to contact.
   
   In addition, other countries often have stronger efforts around means reduction, such as access restriction and barriers at tall buildings or bridges. Each country is unique, and the U.S. could be more open to solutions that relate to its own common means used for suicide.

Worldwide, 800,000 people are known to have died by suicide in 2016. And this is likely an underestimation. We healthcare representatives must do our part to raise our thinking on the issue and treat it like the global public health crisis that it is.

9/25/2018
(Behavioral Health,Child and Youth Services)