Zero Suicide Implementation in St Josephs Health Care

Zero Suicide Implementation in St Joseph’s Health Care London Dr. Sandra Northcott CHAC Innovative Session May 16, 2019

St Joseph’s Mental Health Care Programs: Southwest Centre for Parkwood Institute Forensic Mental Health Care

Overview • The foundational belief of Zero Suicide is that suicide deaths for individuals under the care of health and behavioral health systems are preventable. • For systems dedicated to improving patient safety, Zero Suicide presents an aspirational challenge and practical framework for system-wide transformation toward safer suicide prevention care.

Overview Zero Suicide is a commitment… • To make suicide a “never event” • To ensure patient safety • To train and support clinical staff to do the demanding work of treating suicidal patients

Overview Henry Ford Health System in Detroit • 80% reduction in suicide rate • 9 consecutive quarters with zero suicides • Has since been implemented across the U. S. and internationally

Zero Suicide Model Seven Essential Elements 1. LEAD: Create a leadership driven, safety-orientated culture committed to dramatically reducing suicide among people under our care. Include survivors of suicide attempts and suicide loss in leadership and planning roles 2. TRAIN: Develop a competent, confident and caring workforce. Invest in training such as ASIST

Zero Suicide Model Seven Essential Elements 3. IDENTIFY: Systematically identify and assess suicide risk 4. ENGAGE: Ensure every patient has a pathway to care that is both timely and adequate. Includes collaborative safety planning and lethal means restriction 5. TREAT: Use evidence-based treatments that directly target suicidality

Zero Suicide Model Seven Essential Elements 6. TRANSITION: Provide continuous contact and support, especially after acute care 7. IMPROVE: Apply data-driven quality improvement approach to inform system changes that will lead to improved patient outcomes and better care for those at risk

Implementation at St. Joseph’s Three Phases: • Phase I (July 2016 – December 2017): • Adult Ambulatory and Concurrent Disorders Services • Piloted with ~1, 200 outpatients • Phase II (January 2018 – December 2019) • Inpatient mental health, ACT, remaining outpatient programs • Phase III (January – December 2020) • Community partners, partner hospitals

Implementation at St. Joseph’s Project Team: • • Project Lead Clinical Lead Physician Lead Project Support Analyst • Working Groups • Steering Committee • Advisory Committee

Implementation at St. Joseph’s Workforce Survey (Ambulatory) • Survey administered to all clinical staff & physicians ahead of implementation in their area • Response rate for Adult Ambulatory ~90% • Themes: low to moderate confidence, comfort, and competence in assessing and caring for suicidal patients; looking for more support by organization following an incident; desire for further training • Follow-up survey at end of pilot: all areas of focus significantly improved

Implementation at St. Joseph’s Baseline: • Nurses’ Global Assessment of Suicide Risk (NGASR) completed on 48% of Adult Ambulatory clients and 0% of Concurrent Disorders Clients • No formal process for safety planning • Varying skill and comfort levels among clinical staff • Baseline on inpatient units varied – from 0% to ~60%

Implementation at St. Joseph’s Pilot Results: • Over 90% of patients receive a C-SSRS screener at every visit with their primary clinician • All newly admitted outpatients receive a C-SSRS lifetime/recent assessment • Patients develop a preventative Coping Plan with their clinician • All patients at imminent risk collaboratively develop a Suicide Management Plan

Implementation at St. Joseph’s Training & Education Provided to • Ambulatory C-SSRS training Staff (online module done in groups) • Applied Suicide Intervention Skills Training (ASIST) • Collaborative Assessment & Management of Suicidality (online videos + supplementary text) • Cognitive Behavioural Therapy for Suicidality (3 -day workshop by Beck Institute + consultation sessions)

Implementation at St. Joseph’s Training & Education Provided to Inpatient Staff • C-SSRS training (online module done in groups) • Suicide risk formulation, warning signs, risk and protective factors, safety planning • Lethal means restriction and counselling on access • Documentation/Mental Status Exams

Implementation at St. Joseph’s Budget • Education: • Pilot: $54, 000 • Phase II: $80, 000 • Engagement: • Pilot: $6, 000 • Phase II: $10, 000 • Funding provided through St. Joseph’s Health Care Foundation

For more information on Zero Suicide: • Website: http: //zerosuicide. sprc. org/ • Contact: Katerina Barton: katerina. barton@sjhc. london. ca Sandra Northcott: sandra. northcott@sjhc. london. ca