Forefront staff and allies took part in a remarkable conference in Spokane last month. Titled Achieving Zero Suicide in Our Inland Northwest Communities, the event offered a clear-eyed view of the many deficits in our current model of “suicide care.” It also examined new evidence-based solutions that are saving lives and offering extraordinary promise in suicide prevention, such as:
- The Zero Suicide Initiative, a national resource made up of evidence-based practices, which produces marked and replicable declines in suicide rates but is not yet widely used across our nation;
- Creative, effective regional and local practices being used in geographical pockets of Washington, Idaho and Montana;
- Other, embryonic solutions envisioned and under discussion, but not yet developed.
There was something oddly freeing about examining the ways in which our current system is broken. It took away the mystery. And as the day progressed, many of us felt a huge sense of empowerment as we discovered many ways to move toward a system that delivers “safe suicide care.” A system in which suicide prevention becomes a core responsibility of health care.
Mike Hogan of the National Action Alliance for Suicide Prevention spoke early in the day about the series of beliefs and principles known as the Zero Suicide Initiative. (Download conference presentations here.) His graphic of a sidewalk made not of concrete, but Swiss cheese, aptly illustrated how our current model of suicide prevention allows loved ones not only to slip through the cracks, but to fall through holes, as well.
Here’s one big hole: Basic suicide prevention training teaches us to recognize trouble signs in a loved one or friend and ask directly if they are thinking of killing themselves. Then, we refer them to an emergency room or a mental health provider who often is ill-equipped to help.
As Hogan pointed out, even if the hospital admits a suicidal patient to the psychiatric unit, the result is very likely a handful of days on ice without therapy or planning for future safety. We know from Forefront’s policy work that mental health counselors, social workers, psychologists and primary care providers (who are most likely to see someone leading up to a suicide attempt) historically have had little or no training in suicide risk assessment and management.
Washington is the first state in the nation to require such training for all health care providers. Its lawmakers also have increased the capacity of school districts to recognize and respond to youths at risk for suicide.
“These laws move us in the direction of training large numbers of professionals who are in key positions to help individuals who are at risk for suicide,” said Forefront faculty director Jennifer Stuber, whose policy work and personal loss provided much of the impetus for their passage. “The laws will spur system-level changes by bringing suicide out of the shadows,” she predicted.
Matt Taylor, director of the Montana Safe Schools Center, said suicide is very much on the minds of school leaders throughout the country. “At last year’s National School Safety Conference, there was a lot of talk about suicide being the high-risk event they most often see. It’s not terrorists, or earthquakes. It’s suicide.”
Psychologist Ursula Whiteside, who also is involved in the Zero Suicide Initiative, discussed her work helping clients learn how to manage their suicidal thoughts. Her website, NowMattersNow.org, is an online tutorial of sorts in which individuals talk about how they keep themselves safe from those thoughts. The Zero Suicide Initiative also advocates regular screening through health care providers and follow-up care after a crisis or discharge. Its website gives more information.
The conference, which took place at Gonzaga University, drew about 300 people from Washington, Idaho and Montana. Organizers hope to create a tri-state network of collaborators, to continuing sharing successful strategies, similar to those highlighted at the conference. For example:
• Elaine Frank of the New Hampshire Gun Shop Project described how gun shop owners started talking about suicide prevention in their state. Fellow panelist gun shop owner Robin Ball of Spokane told of working with an individual who had suicidal thoughts and of leaning on her son’s Air Force training for guidance. Ball and others agreed that there is common ground among gun owners and suicide prevention advocates, and that members of the gun culture could hold their own conversation about how to create firearm safety for friends and family members threatened by thoughts of suicide.
• Police Chief Scott Haug of Post Falls, Idaho, discussed his practice of sending volunteer police chaplains to offer support after every response to a suicide threat.
• Julie Rickard, a psychologist with Columbia Valley Mental Health, responded to a 2012 spike of 30 suicides in Chelan and Douglas counties by training every physician in the community how to assess suicide risk. Today, every new doctor in those communities is coached in these skills. Rickard also launched systematic QPR training, equipping 29 instructors in different sectors of the communities. All told, more than 3,000 people received training in a year. Training continues. In 2014, the Columbia Valley had just four suicide deaths, a fraction of the number in the years before the spike.
By all accounts the conference created learning and inspiration. At every break, participants talked and talked. Speakers, organizers and participants remarked on the high-energy feel, and audience stayed in their seats through out an intense day.
The common denominator for all solutions? Implementation will take hard work. But for those of us who know that today’s system is no system at all, that too many husbands, sons, brothers, daughters, grandmothers are dying—what’s some hard work?
It’s a great deal easier than what we’ve been through. So this conference was, in some ways, the start of a movement. Or, depending on your perspective, an injection of new energy into a movement that’s been going on for years. — by Marny Lombard
Forefront volunteer Marny Lombard, a suicide loss survivor who lost her son two years ago, was one of the conference organizers, along with Dr. John Osborn, longtime VA physician and a suicide loss survivor; and Dr. Paul Quinnett, founder of QPR, internationally respected suicide prevention expert and Forefront advisory board member. See www.ZeroSuicideInlandNorthwest.org and www.facebook.com/ZeroSuicideInlandNorthwest for more information.