Culture of Caring

After you realize a person has been struggling with suicidal ideation and they finally agree to get help, what happens next? Will they recover?

Ideally, they will receive professional care. But what does that look like?

Therapy and medication

Evidence-based treatments and therapies delivered by trained providers will focus directly on suicidal thoughts and behaviors. Treatment for mental health disorders and substance abuse might be part of the plan, depending on the individual’s needs. Suicidal ideation tends to recur even after successful treatment, so a safety plan is a critical tool and should be put in place right away.

Safety Plan

A good safety plan is designed with the participation of the patient. It needs to be clear and easy to remember. Most plans include:

• Awareness of triggers.
• How to redirect negative thoughts by engaging in enjoyable activities.
• Ways to engage others.
• How to reach out to help, and contact information.

Patients with suicide risk need continuing access to care during high-risk periods, especially when they experience stress or trauma. 

Continuous Care

Just as with any other ongoing health disorder, like diabetes or heart disease, continuing to monitor the condition is essential to long-term well-being. Students returning to school after treatment need a re-entry plan and regular check-ins with school-based mental health professionals. Parents will need to sign medical release forms so the school can share information with the providers.

Coordinating medical and behavioral systems of care means a primary care doctor communicates with the mental health care provider. If a patient has received treatment, all providers should participate in discharge planning procedures to make sure the patient will have access to follow-up care.

In areas where mental health providers may not be readily available, look for telepsychiatry or teletherapy providers who can meet with patients online.

Primary care providers can access training to learn about suicide prevention interventions, such as counseling on reducing access to lethal means and safety planning.

Deeper Dive: Zero Suicide Framework for Safe Suicide Care

We don’t know what we don’t know. Look for expert guidance to provide a broader picture of what can be done to support someone who is at risk.

The Zero Suicide Framework is designed to help health and behavioral health care systems prevent suicide. The following list is a summary based on the model developed by the ZERO SUICIDE Institute.  

The Zero Suicide framework includes seven elements that experts have identified as the core components of safe care for individuals with suicidal thoughts and urges. When implemented together and with fidelity, suicide and suicide attempts by people who are in health care settings can be reduced.

Zero Suicide Elements

LEAD

Leadership must convince staff to see and believe that suicide can be prevented. 

TRAIN

Train a competent, confident, and caring workforce. Interactions with staff are a critical part of a patient’s experience.

IDENTIFY

Identify individuals with suicide risk via comprehensive screening and assessment. People should be screened at every visit with a health care professional and all health care providers need to be comfortable asking about suicide directly and without judgment.

ENGAGE

Engage all individuals at risk of suicide using a suicide care management plan. Talk with individuals openly about their suicide risk and the treatment available to address it. Those who screen positive for suicide should develop a collaborative safety plan with a clinician or health care worker before going home.

TREAT

Treat suicidal thoughts and behaviors directly using evidence-based treatments.

Research in the last 10 to 15 years has emerged to suggest that suicide can be targeted directly through treatments that focus explicitly on the suicide risk, both to keep patients safe and to help them thrive.

Cognitive Therapy for Suicide Prevention (CT-SP), dialectical behavior therapy (DBT), and the Collaborative Assessment and Management of Suicide (CAMS) all reduce suicide and suicidal behaviors.

TRANSITION

Patients are at the highest risk for suicide immediately following a psychiatric hospitalization.

Continuing interventions and support following discharge are critical. Currently, only about half of patients receive any outpatient care during the first week after psychiatric hospital discharge, and one-third receive no mental health care at all during the first month after discharge.

Providers should routinely maintain contact with patients following discharge, send appointment reminders, and ensure that patients keep going to appointments.

IMPROVE

Improve policies and procedures. Continuous quality improvement must be implemented in a safety-oriented, "just" culture free of blame for individual clinicians when a patient attempts or dies by suicide, which would include supporting clinicians and staff following the suicide death of a patient.

What is Your Role?

Whether you are a family member, friend, loved one, teacher, counselor, doctor, clergy, or connected in some other way to a suicidal person, your role is to take action.

What action you choose to take is based on what you already know and what you need to learn.

Educate Yourself

• Learn what effective care for suicide risk should look like. The Zero Suicide website is a reliable place to start.
• Consider how the elements listed could improve your work and home environments.
• To find out about suicide prevention in Primary Care, Behavioral Health, and Emergency Departments, go to the Zero Suicide website.
• What are the connections between substance abuse and suicide prevention?
• Look at 
  • Crosswalk of Suicide Prevention and Substance Abuse
  • SPRC Substance Abuse and Suicide Prevention Collaboration Continuum
  • TIP 50: Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment.

• Can you investigate ways to reduce financial, cultural, and logistical barriers to effective suicide care?
• Review the SPRC’s Best Practices Registry.
• Look at interventions used by professionals with people who have survived suicide attempts or are at risk. David Jobes, PhD, on Evidence-Based Psychological Treatments and Suicide-Specific Brief Interventions

If you think someone is seriously contemplating suicide and has made a plan, get help right away. Don't worry about making them mad at you – you're trying to save a life!

Call or text 988 Suicide & Crisis Lifeline or visit https://988lifeline.org/

The Lifeline is a 24-hour toll-free phone line for people in suicidal crisis or emotional distress and those who are concerned about them.

An online chat option is also available.

A Culture of Caring: A Suicide Prevention Guide for Schools (K-12) was created as a resource for educators who want to know how to get started and what steps to take to create a suicide prevention plan that will work for their schools and districts. It is written from my perspective as a school principal and survivor of suicide loss, not an expert in psychology or counseling. I hope that any teacher, school counselor, psychologist, principal, or district administrator can pick up this book, flip to a chapter, and easily find helpful answers to the questions they are likely to have about what schools can do to prevent suicide.