Filling Health Care Gaps to Prevent Suicides in Michigan

From Healthy People 2020 Stories from the Field, a series highlighting communities across the Nation that are addressing the Leading Health Indicators (LHIs).

Suicide is the tenth leading cause of ZEROSuicide Logodeath in the United States — and suicide rates are on the rise in almost every state. But communities and health systems are working together to help intervene.

In 2001, Henry Ford Health System (Henry Ford) in Detroit, Michigan set out to eliminate suicides in its behavioral health system. Their goal of “zero suicides” became the foundation for the Zero Suicide initiative, which is now supported by the Suicide Prevention Resource Center (SPRC) and used by health care systems across the Nation. Since implementing this framework, Henry Ford has maintained a significantly reduced suicide rate in patients who come through the doors of its facilities.

Paving the Way for Zero Suicide

Dr. Brian Ahmedani, Director of Research, Behavioral Health Sciences at Henry Ford, knew it was a bold goal. “We wanted ‘perfect care’ — and to us, that meant zero suicides,” he says. “But there wasn’t a lot out there that showed us how to do it.” So Ahmedani and his colleagues decided to incorporate suicide prevention into every level of the health system over time.

What they came up with was the Perfect Depression Care Zero Suicide Initiative. This initiative informed the development of the nationwide Zero Suicide framework — and became the first program in the United States linked to significant decreases in suicides among behavioral health patients.

Building a Comprehensive Suicide Prevention Framework

Since mental health treatment is so often siloed within the health care system, Henry Ford’s integrated approach to suicide prevention was really a departure from the status quo. Julie Goldstein Grumet, SPRC’s Director of Health and Behavioral Health Initiatives, says the integration piece is key. “The bottom line is that the health care system as a whole is not prepared to prevent suicides.”

Ahmedani agrees, and stresses that providers often don’t receive adequate suicide prevention training. Conventional suicide prevention efforts tend to use specialized interventions once a patient is at immediate risk. But when Henry Ford looked at its own system, it was clear that patients dying from suicide often weren’t making it to these services.

“Patients who weren’t formally diagnosed with a mental health disorder or identified as having risk factors for suicide were slipping through the cracks,” says Ahmedani. “Now, when a patient arrives with a mental health issue or any risk factors for a mental health condition, we automatically classify them as at-risk for suicide and begin collaborative prevention efforts.”

Success by the numbers

Data from Henry Ford Health System show that the Zero Suicide framework can successfully and significantly reduce suicide rates.

Since the initiative was first implemented in 2001, the suicide rate in behavioral health patients at Henry Ford:

Additionally, between 1999 and 2010, average suicide rates for members of the Henry Ford health maintenance organization health plan were stable, while the average suicide rate for the state of Michigan significantly increased.

Prioritizing Suicide Prevention in the Health Care System

Ahmedani explains that a major barrier to suicide prevention is the commonly held belief that suicide isn’t actually preventable. “There’s a stigma to suicide prevention among clinicians,” he says. “People don’t believe that it’s possible, or they believe that it’s too difficult — they think we’re better off focusing on other high-profile medical conditions, like cancer.”

The field of suicide prevention research is only about 20 years old — much more recent than research on prevention programs for other medical conditions. “Great suicide prevention research is happening,” says Goldstein Grumet. “But we need more — we need to show the country that suicide is preventable.”

Looking Ahead

Ahmedani and Goldstein Grumet hope to see the Zero Suicide framework adopted by even more health care systems across the country. Kerri Nickerson, SPRC’s Director of Grantee and State Initiatives, encourages public health professionals to think about how to improve suicide prevention efforts at the community level, too. “We know that many individuals who have died by suicide didn’t have a known mental health condition at the time of their death and may not have touched a health care system — that’s why we all need to play a role in suicide prevention,” says Nickerson.

On the horizon for Zero Suicide and SPRC is an evaluation study that will measure the success of the initiative across 6 diverse health systems from around the country. Over 1,000 health organizations have adopted the Zero Suicide framework, but Henry Ford and SPRC agree that there’s still a lot of work to be done.

“The national suicide rate is still rising,” Ahmedani says. “We celebrate our program’s victories, but every day is a new opportunity — and we have a long way to go.”

About Stories from the Field

This series highlights how communities across the Nation are addressing the Healthy People 2020 Leading Health Indicators (LHIs). LHIs are a subset of 26 Healthy People 2020 objectives that communicate high-priority health issues. Tackling the LHIs appropriately will dramatically reduce the leading causes of death and preventable illnesses.

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