Eliminating suicide
26/02/16 05:40
Detroit, Michigan, hasn’t been getting a lot of good press lately. The departure of many automobile manufacturing plants has led to high unemployment, the collapse of the city’s financial structure, decreases in government programs, increases in unemployment, poverty, and a host of other problems. Flint, a city just over 60 miles away has been in the national headlines for its severe water problems. No one knows for sure what the impact of over two years of severe lead poisoning through the city water system will be. There is agreement that the crisis, which started in 2014, will have lasting negative impacts.
I could devote an entire blog to problems failures of urban infrastructure and poverty in Michigan, but there have been plenty of articles on the subject.
There is, however, program in Detroit that has been receiving a lot less press that is worthy of note. In 2001, the Henry Ford Health Care System instituted a series of changes aimed at decreasing the rate of suicide in the area. Granted, the suicide rate was already significantly lower in Detroit than in the nation as a whole. The population served by HFHCS had a suicide rate of 89 per 100,000 compared with a national average of 230 per 100,000. Still the program set its sights on achieving a zero suicide rate.
The program began with several innovative features. They established a consumer advisory panel to assist with program design, devised a protocol for screening all patients during the initial contact and assigning levels of suicide risk, and established new ways for patients to access care including drop-in, same day appointments and e-mail support. They also made suicide prevention training mandatory for all of the staff of the facility.
The results were dramatic. In the first four years of the program suicide rates in the area dropped from 89 per 100,000 to 22 per 100,000. In the past 15 years there have been periods of up to 30 months when there were zero suicides among patients who had contact with the program. The goal of zero suicides became an achievable target and has been the standard for the program in recent years.
The program has earned national and international recognition for its effectiveness. Programs in other cities and in countries around the world are being based on the success of the Detroit model.
In the past couple of weeks, I’ve been thinking about that model a great deal. I have been working with a couple of different individuals who are at risk for suicide. And obtaining any kind of care for them is a challenge. In one case, I could find no options for same day care in our city. The individual was known by those in the system and had been previously treated and was resistive to care. Still, it was frustrating to not be able to access care. In our city the combination of significant substance abuse with another diagnosable mental disorder makes treatment very difficult to obtain.
This is a life and death issue in our community. I am not involved in every suicide in our area, but I am aware of two deaths by suicide in our county this week. In one case all of the danger signs were present: prior suicide attempt; family history of mental disorder; substance abuse; family violence; and easy access to the means of suicide.
The suicide rate in our community is over double the national average. In general suicide rates increase from east to west in South Dakota, making our end of the state the site for well over half of the suicides in our state despite the population being greater at the other end of the state.
Accessing a full continuum of mental health and substance abuse services is difficult in our area. Still there are steps that could be taken by institutions in our area that could have a large impact. The Henry Ford Health Care System started with steps that could be taken by organizations of any size in any location such as the establishment of an advisory panel of consumers and mandatory suicide prevention training for all employees.
Working outside of the area’s regional health care system, however, it is difficult to determine where to start in the process of asking for change. Despite areas of excellence in care, the establishment of consumer advisory councils isn’t a priority for our system of hospitals and clinics. Despite a steady stream of suicide victims and victims of near suicides, suicide prevention training is not a priority for the employees of the system.
The emergency room of our hospital has a protocol for screening physical injury and illness and establishing priorities for care. No such system exists for assessing mental health status of patients to reach out to the hospital for care. Mental health services are delivered at a satellite facility across town and although we do have a crisis care facility, there is little consumer education on how to access that care.
Back to Detroit. The Henry Ford Health Care System has set the goal of eliminating suicide. They now screen every single patient for risk of suicide, not just those who present with mental health problems. Care is then tailored to the needs of patients identified as being at risk. Now, it is important to note that HFHCS is a private hospital used mainly by those with health insurance. Not every resident of Detroit has access to its services. Still the impact they have had on their own patient population has been enough to produce a dramatic decrease in overall suicide rates in the community.
Around the world a person dies by suicide every 40 seconds, according to the World Health Organization. Every death directly affects dozens of surviving individuals. Having someone close to you die by suicide increases the risk that you might also die by suicide. Proper treatment of those suffering trauma from the loss of a loved one to suicide is critical to preventing more death.
I stand with the people in Detroit. My goal is eliminating suicide in our community.
It is a cause worthy of our attention and energy. It is a topic about which I’ve blogged before and one about which I will blog again and again.
I could devote an entire blog to problems failures of urban infrastructure and poverty in Michigan, but there have been plenty of articles on the subject.
There is, however, program in Detroit that has been receiving a lot less press that is worthy of note. In 2001, the Henry Ford Health Care System instituted a series of changes aimed at decreasing the rate of suicide in the area. Granted, the suicide rate was already significantly lower in Detroit than in the nation as a whole. The population served by HFHCS had a suicide rate of 89 per 100,000 compared with a national average of 230 per 100,000. Still the program set its sights on achieving a zero suicide rate.
The program began with several innovative features. They established a consumer advisory panel to assist with program design, devised a protocol for screening all patients during the initial contact and assigning levels of suicide risk, and established new ways for patients to access care including drop-in, same day appointments and e-mail support. They also made suicide prevention training mandatory for all of the staff of the facility.
The results were dramatic. In the first four years of the program suicide rates in the area dropped from 89 per 100,000 to 22 per 100,000. In the past 15 years there have been periods of up to 30 months when there were zero suicides among patients who had contact with the program. The goal of zero suicides became an achievable target and has been the standard for the program in recent years.
The program has earned national and international recognition for its effectiveness. Programs in other cities and in countries around the world are being based on the success of the Detroit model.
In the past couple of weeks, I’ve been thinking about that model a great deal. I have been working with a couple of different individuals who are at risk for suicide. And obtaining any kind of care for them is a challenge. In one case, I could find no options for same day care in our city. The individual was known by those in the system and had been previously treated and was resistive to care. Still, it was frustrating to not be able to access care. In our city the combination of significant substance abuse with another diagnosable mental disorder makes treatment very difficult to obtain.
This is a life and death issue in our community. I am not involved in every suicide in our area, but I am aware of two deaths by suicide in our county this week. In one case all of the danger signs were present: prior suicide attempt; family history of mental disorder; substance abuse; family violence; and easy access to the means of suicide.
The suicide rate in our community is over double the national average. In general suicide rates increase from east to west in South Dakota, making our end of the state the site for well over half of the suicides in our state despite the population being greater at the other end of the state.
Accessing a full continuum of mental health and substance abuse services is difficult in our area. Still there are steps that could be taken by institutions in our area that could have a large impact. The Henry Ford Health Care System started with steps that could be taken by organizations of any size in any location such as the establishment of an advisory panel of consumers and mandatory suicide prevention training for all employees.
Working outside of the area’s regional health care system, however, it is difficult to determine where to start in the process of asking for change. Despite areas of excellence in care, the establishment of consumer advisory councils isn’t a priority for our system of hospitals and clinics. Despite a steady stream of suicide victims and victims of near suicides, suicide prevention training is not a priority for the employees of the system.
The emergency room of our hospital has a protocol for screening physical injury and illness and establishing priorities for care. No such system exists for assessing mental health status of patients to reach out to the hospital for care. Mental health services are delivered at a satellite facility across town and although we do have a crisis care facility, there is little consumer education on how to access that care.
Back to Detroit. The Henry Ford Health Care System has set the goal of eliminating suicide. They now screen every single patient for risk of suicide, not just those who present with mental health problems. Care is then tailored to the needs of patients identified as being at risk. Now, it is important to note that HFHCS is a private hospital used mainly by those with health insurance. Not every resident of Detroit has access to its services. Still the impact they have had on their own patient population has been enough to produce a dramatic decrease in overall suicide rates in the community.
Around the world a person dies by suicide every 40 seconds, according to the World Health Organization. Every death directly affects dozens of surviving individuals. Having someone close to you die by suicide increases the risk that you might also die by suicide. Proper treatment of those suffering trauma from the loss of a loved one to suicide is critical to preventing more death.
I stand with the people in Detroit. My goal is eliminating suicide in our community.
It is a cause worthy of our attention and energy. It is a topic about which I’ve blogged before and one about which I will blog again and again.