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The New York State Office of Mental Health’s Suicide Prevention Center recently collaborated with the Upstate and New York City Poison Control Centers to develop Information for Mental Health Providers. this describes what poison centers do and how they can help clinicians in suicide prevention, particularly in lethal means reduction.
New York State has received national recognition for its work integrating suicide prevention into health and behavioral health systems. As called for in the New York State Suicide Prevention Plan, we set out to systematically support health systems in reducing suicide deaths among those receiving care—beginning with settings that care for those most at-risk. Our evolving approach, refined over the course of implementing several large, federal suicide prevention grants, is called AIM for Zero. It draws heavily on the national Zero Suicide Model and combines it with a helpful clinical framework. It was developed by experts in New York called AIM (Assess, Intervene, Monitor).
The Zero Suicide Model:
Zero Suicide is the country’s leading model for suicide prevention in healthcare. It is both an aspirational concept and a practical set of tools based on empirical evidence:
a majority of suicide deaths occur among individuals with recent contact in the healthcare system, often within the 30 days after discharge.
Implementation of the Zero Suicide Model starts with a commitment from health system leadership to reducing suicide deaths among all those receiving care. Click here for more information on Zero Suicide and to access the Zero Suicide toolkit.
The AIM Model provides a clinical framework for reducing suicide risk. Developed by Dr. Barbara Stanley, Director of the Suicide Prevention Training, Implementation and Evaluation (SP-TIE) program at Columbia University and the New York State Psychiatric Institute, the AIM Model highlights three domains of clinical practice essential to reducing suicide risk:
If you’re interested in the AIM for Zero Suicides Implementation Guide, click here.
The New York State Office of Mental Health has launched or supports several Zero Suicide initiatives across the state, utilizing the AIM for Zero approach. While the overarching approach is the same, adaptations have been made to accommodate unique challenges of different treatment settings.
Visit our Suicide Safer Care Practices by Setting page to learn more about each practice.
The Attempted Suicide Short Intervention Program (ASSIP) is a promising three session intervention for patients who have attempted suicide within the past 60 days. The goal of ASSIP is to listen to an individual’s story and to respect each person as experts of their own actions. The program helps people understand their suicidal crisis and find ways to establish effective coping strategies for the future. ASSIP is now available via Telehealth to individuals 18 years of age and above who are residents of New York State as part of ongoing research. ASSIP is designed to complement, not replace, other recommended treatment; the ASSIP team will coordinate with the client’s primary treatment team.
Clinicians working with individuals from different backgrounds, including but not limited to cultural, ethnic, socioeconomic, or sexual orientation, must be aware of the role of cultural competency in working with diverse populations. For instance, a presenting behavior may have different connotations and meaning in the individual’s culture than in the culture of the clinician. Cultural humility does not require clinicians to be experts in every culture, but rather implies that clinicians must be aware of how their own interpretation of symptoms and suicidal behaviors impact the assessment and therapy. Not fully understanding an individual’s views on suicide may result in an insufficient understanding of risk and protective factors; this may exacerbate suicidal thoughts and behaviors rather than lessening symptoms. For example, when a group of American Indian/Alaska Native (AI/AN) youth describe their culture’s concept of suicide, they report that suicide is considered an expression of the tribe’s current and past suffering, not an individual issue. Hence, for the AI/AN population, closeness to the tribe is a protective factor, and including members of the tribe in the intervention yields culturally enhanced treatment.¹
If an individual does not speak English, an interpreter or a language line will be needed. Using a family member, especially a child, to translate should be avoided. The clinician needs to be aware of basic skills in providing therapy through an interpreter, such as asking questions directly of the patient or client, instead of asking the interpreter “ask if she…” or “tell her that.” Therapy with an interpreter impacts the therapeutic encounter, as therapy no longer consists of a dyad but a triad. While being aware of the interpreter’s presence, the clinician should talk to the patient or client, read body language, and show empathy to the patient or client, not the interpreter.²
The Suicide Prevention Resource Center further recommends that mental health professionals and administrators:³
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Individuals who have direct experience with suicide or suicide loss have an important role to play in suicide prevention planning, including support services, treatment, community suicide prevention education, and the development of guidelines and protocols for support groups. Including people with lived experience is consistent with mental health recovery practices and person-centered care practices.
Activities designed to help anyone who has been suicidal share the following core values:
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People often turn to family and friends for help, even when they do not seek help from professional caregivers. A strong support network can be a safety net in times of crisis and a trusted resource during recovery. Patient and family-centered care is an approach to the planning, delivery, and evaluation of behavioral health care that is grounded in mutually beneficial partnerships among professional caregivers, patients, and families. Families are essential allies, not only in direct care interactions, but also in quality improvement, safety initiatives, educating health professionals, research, facility design, and policy development. In suicide-safer care, family members and significant others can play a valuable role in risk assessment, safety planning, and monitoring.
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While agencies, lawmakers, families, and communities contend with the burden of suicide, behavioral health professionals face another issue: How do we respond to the emotional and psychological toll that a suicide of a client has on professional caregivers? What are the best ways to support both staff and clients? While this remains a relatively new area of research, it has been estimated that each year 15,000 mental health professionals experience the loss of a client to suicide. For professional caregivers, concerns about litigation, stigma around suicide, and fear of negative reactions of colleagues can make the pain much greater than what was caused by the loss itself.
Postvention is a term used to describe an organized response in the aftermath of a suicide to facilitate the healing from the grief and distress of suicide loss, mitigate the negative effects of exposure to suicide, and prevent suicide among people who are at high-risk after such exposure. Postvention plans in behavioral health settings typically include procedures that mitigate the impact a client suicide can have on the professional identity of professional caregivers, as well as on their relationship with colleagues and their clinical work.
The following resources can help organizations dealing with a client’s suicide or opioid overdose. They discuss:
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For non-behavioral health organizations resources visit our Communities and Coalitions page.
Professional caregivers who encounter high levels of interpersonal stress and loss in their jobs are at increased risk for mental health symptoms, vicarious traumatization, and compassion fatigue. Self-care is an essential survival skill for those who do the demanding work of treating and supporting suicidal clients, regardless of credentials or professional role. Self-care refers to practices that can reduce stress and help maintain/enhance short and long-term health and well-being, both personally and professionally.
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