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Jan 16, 2018

Zero Suicide – Hope for a Rural Model

As I've already noted, Wyoming has one of the highest suicide rates in the nation.  The United States overall has a high suicide rate, when compared with other countries, and so in 2010 the nation's Department of Health and Human Services launched the National Action Alliance for Suicide Prevention.  Through this initiative, suicide as a significant health problem began receiving increased national attention. 

Unfortunately, suicide rates continue to rise.  In Wyoming, suicide is the 5th leading cause of death, with rates per 100,000 people at nearly twice the national average.  In other posts I've touched briefly on some of the possible contributing factors including isolation, and a culture in which people believe they should be strong and take care of things on their own.  Long, dark, cold winters may also add another difficult dimension for those already suffering from depression.

In response to high suicide rates, Wyoming health care providers recently launched the Zero Suicide Initiative, which focuses on early detection of high risk individuals, and implementing preventative measures to lower risk and keep patients safe.  When individuals have been hospitalized due to risk, the program emphasizes follow up treatment and monitoring to ensure the individual maintains treatment gains.

Through this initiative, leaders have identified the elements needed for the reduction (and eventual elimination) of suicide, which are:  a commitment to change, establishing program processes, collecting data to track progress, training all staff to be competent in suicide risk assessment, and appropriate follow-up to prevent high risk individuals from falling through the cracks.  In some areas of the state, for those clients who are repeatedly hospitalized and who do not seek follow-up treatment on their own, an additional initiative is under way to court-order treatment.

One of the most notable aspects of the program is that it involves making risk assessment a routine part of health care.  Statistics tell us 45% of those who complete suicide see their primary care physician in the month before they take their own life.  And so, training all health care personnel to screen at every contact will help us identify high risk individuals before it's too late.  The next step is for these same health care providers to appropriately refer and follow up to ensure the patient is being seen and treated.  It's a tall, but attainable order.

For those already hospitalized due to suicide attempts or for being high risk, stepping down from inpatient care requires comprehensive follow-up treatment and monitoring to ensure they do not return to high risk status.  Comprehensive includes thrice weekly group (known at my own agency as MHIOP – Mental Health Intensive Out Patient), and minimum one individual psychotherapy session weekly.  Monitoring means checking on clients after missed appointments, including welfare checks if needed, and weekly assessment to monitor risk levels. 

All levels of health personnel are to be included in the program, but it will include non-routinely involved personnel such as coroners, who will participate in the data collection process to contribute  postmortem information to the broader knowledge base needed to fully understand the hows and whys of completed suicides.

The program is both preventative, and prescriptive, with the overarching goal being to eliminate suicide.  Because it's not enough to just reduce suicide rates, is it?  Even one is one too many.

The program has only recently been implemented, but all are eager to see the initial data as we hope for reduction in the rates of suicide in the areas where this program is in place.

As always, I'd love to hear from you about challenges and/or solutions you've worked with in your own state regarding the prevention of suicide.
Stormy Filson is an independently licensed counselor living and working in Wyoming, with special interests in treating trauma, community building, and empowering women.  She is also passionate about writing, photography and film.

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