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St Joseph’s Mental Health Care Programs:

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:. Parkwood Institute. Southwest Centre for Forensic Mental Health Care. Overview.

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St Joseph’s Mental Health Care Programs:

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  1. Zero Suicide Implementation in St Joseph’s Health Care LondonDr. Sandra NorthcottCHAC Innovative SessionMay 16, 2019

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

  3. 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.

  4. 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

  5. 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

  6. Zero Suicide Model Seven Essential Elements • 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 • TRAIN: Develop a competent, confident and caring workforce. Invest in training such as ASIST

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

  8. Zero Suicide Model Seven Essential Elements • TRANSITION:Provide continuous contact and support, especially after acute care • 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

  9. 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

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

  11. 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

  12. 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%

  13. 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

  14. Implementation at St. Joseph’s Training & Education Provided to Ambulatory Staff • C-SSRS training (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)

  15. 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

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

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

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