Each year, over 800,000 individuals die by preventable suicide. That is almost the entire population of South Dakota perishing annually from a curable emotional disorder. Capital Area Counseling Service, Inc. (CACS) is enacting Suicide Safe Care guidelines developed by the research consortia known as
Zero Suicide. Zero Suicide is an organization dedicated to ending the taboos and stigmas associated with suicide and mental illness by teaming up with healthcare systems and crisis interventionists. The Zero Suicide approach can potentially save those 800,000 valuable lives. With the Zero Suicide inspired Suicide Safe Care protocol, Capital Area Counseling can now more effectively support and screen all the people coming to their agency.
Currently, healthcare advocates are giving mental health the recognition it has needed for so long. The pendulum of awareness and action is swinging toward holistic wellness, which includes mental health, addiction and prevention services. Zero Suicide initiatives, such as the Suicide Safe Care protocols at Capital Area Counseling, are data-driven curriculum geared toward the improvement of healthcare workers’ preparedness, expertise, and professionalism when dealing with individuals with suicidal thinking. Removing the stigma of mental illness by changing our culture and how people view mental illnesses will be important to addressing suicides in the future. Providing healthcare workers and emergency crisis centers with the step-by-step training and goals can ultimately achieve the intention of ending suicide completely. Capital Area Counseling plans to do just that in Central South Dakota.
When healthcare systems have enacted Zero Suicide plans, such as the Capital Area Counseling’s Suicide Safe Care, there is evidence of high success rates. Modern healthcare has the potential to make astronomical strides. Proof of this is seen with almost the total elimination of smallpox, the drastic reduction of polio and the increase of cancer survivors. A similar data-driven analysis of suicide helps healthcare workers and crisis centers have a step-by-step plan to support, encourage, and communicate effectively with clients: “The core recommendations of Zero Suicide in Healthcare initiatives fall into three categories: Leadership, Continual Improvement, and Patient Support”. (IIMHL) The goal of Zero Suicide is for a suicide-free world. Eight countries joined in on the International Initiative for Mental Health Leadership (IIMHL) which includes the United States, Sweden, New Zealand, Canada, Australia, England, Republic of Ireland, and Scotland. Incorporating national recognition will aide individuals going through crisis to not feel so isolated. From the small counties to the global organizations, Zero Suicide aims to have positive and rippling impacts.
To understand the process of Zero Suicide, it is important to know what it is not. It is not a zero tolerance authoritarian approach. Even though the goal is zero suicide, it is the intention of Zero Suicide to reduce suicide by having open lines of communication among healthcare providers and their clients. Zero Suicide is not is a punishment. Healthcare workers and clinicians are not be held to an unreasonable standard of care. But rather the standard set out by Zero Suicide. Finally, the Zero Suicide approach is not easy. Although effective and worthwhile, Zero Suicide will not be simple or a quick fix to the global epidemic of suicide. Complex problems need complex, continuous and genuine solutions.
What has been learned? When specific clinics and centers used the Zero Suicide approach, there was marked success and improvement. One example of this would be the Henry Ford Health System pilot study—in an eight-year sample, the number of suicides with their clients fell by 75%. Some working action steps to fulfilling the Zero Suicide goal include but are not limited to: setting target goals every ninety days, meeting with staff regularly to discuss “trends” in addiction and mental health, creating individualized relapse prevention plans, recognizing individual triggers in clients and clinicians, providing mindfulness based stress reduction techniques, knowing the warning signs of suicide, educating the public (including youth) and coordinating follow up services (Crisis Now: Transforming Services is Within Our Reach, 2016). Even though the processes seem so extensive, when used properly and diligently, Zero Suicide is proven to work.
Suicide is a dilemma facing countries around the world. However, suicide is especially hard for small town America. Although the numbers of suicide are much less, the personal impact is just as large. Many people in rural and frontier areas are intertwined with each other through community activities, school events and church. Suicide deeply impacts us, because we as Central South Dakotans are so connected.
That is the reason Capital Area Counseling set about to do all they can by decreasing suicide. In the fall of 2015, they formed the Suicide Safe Care Implementation Team of clinicians and a Board Member to read and analyze the research and begin planning for implementation. The overarching concept is to screen, assess, engage, and save clients contemplating suicide. One specific step of the implementation involved Qualified Mental Health Professionals, those CACS clinicians called upon to complete examinations of individuals experiencing suicidal thoughts, to study best practices of other clinician’s across the country. The implementation Team continued its work figuring out the protocols and how to track the data, which will be used to show progress and make improvements to the process. Now the preliminary work is finished and the plan is to incrementally implement new protocols, including screening every new and readmitted client for suicidal thoughts. The entire agency has been trained and the implementation began on November 1st.
Dennis Pfrimmer, the CEO at Capital Area Counseling states, “Reducing and preventing suicide where possible is the number one priority of our agency. Our clinical staff is well-trained in assessing the risk of suicide and our administrative staff understand they too are part of the solution. All of our employees have been trained in Suicide Safe Care. They know, understand and are passionate about reducing suicide among our friends and neighbors in Pierre and the surrounding area.”
How is Suicide Safe Care different from what Capital Area Counseling has been doing in the past? First, Suicide Safe Care is a step-by-step response that is data-driven. Procedures are based on previous successes of Zero Suicide initiatives. Consumers of mental health services, professionals, and other care givers will experience a uniform response when someone is at risk of suicide. Second, there will be suicide screenings at admission and during therapy sessions as needed. There will be a focus on high risk time frames, such as following discharge from a psychiatric hospital. If individuals respond “yes” to any of the questions concerning suicidal thinking, they will be identified as potentially at a higher risk and steps will be implemented to keep them safe. CACS will be very intentional about discussing suicide up front and openly with all clients. Third, Suicide Safe Care is the best alternative available to avoid psychiatric hospitalization. Last, Suicide Safe Care is one more safeguard against death by suicide in our community.
Our region has utilized the services at Capital Area Counseling since 1968. Capital Area Counseling is a 501c3 not-for-profit corporation established to meet the mental health and addiction needs in Central South Dakota. The agency employs over ninety employees, who provide services in their offices or in the community, such as at schools throughout the area. CACS serves the nine counties of Hughes, Stanley, Haakon, Jones, Lyman, Buffalo, Hyde, Sully and Potter. The agency has an annual budget of $5.2 million.
In conclusion, Suicide Safe Care is a system of care that saves lives. There is research and data-driven evidence to back up its successes. Capital Area Counseling’s implementation of Suicide Safe Care aims to significantly reduce the number of suicides within our local healthcare systems. Suicide does not have to be something that “just happens”. There are multiple opportunities to intervene. No longer should mental health be something that is hushed or hidden. When openly discussed and addressed effectively, mental illness and addiction, including suicide, can be successfully managed one person at a time.
Author: Lauren Barrett, Capital Area Counseling Service, Inc.
Last Reviewed: December 28, 2016