Magellan Health

Programs

Suicide Prevention

National Suicide Prevention Week, Sept. 8 to 14

Suicide takes more lives than homicide in the U.S.  Learn the warning signs and how to help a person at risk.

Suicide Prevention Webinar replay now available

In recognition of World Suicide Prevention Day (Sept. 10), the Arizona Department of Health Services/Division of Behavioral Health Services and Magellan Health Services of Arizona hosted a panel discussion on suicide prevention via webinar. Entitled “Closing the Gap to Zero Suicides,” the webinar featured a panel of leaders from ADHS/DBHS, Magellan, the VA, and service providers JFCS and TERROS—all of whom have been involved in the Arizona Programmatic Suicide Deterrent System. To view/listen to the replay, access http://magellanhealth.adobeconnect.com/p4tqa55kvsu/.

Driving suicides to zero for people living with mental illness

Arizona Programmatic Suicide Deterrent System: The Mission

As the Regional Behavioral Health Authority for central Arizona, Magellan Health Services of Arizona oversees the system of care for more than 20,000 people with serious mental illness (SMI). This group of people is particularly at risk for suicide. In fact, they are six to 12 times more likely to die by suicide than the general population, and their risk is higher than other those in other at-risk groups.

Faced with these statistics, Magellan partnered with the Arizona Department of Health Services' Division of Behavioral Health Services (ADHS/DBHS), Magellan's network of service providers, and other community stakeholders to form the Arizona Programmatic Suicide Deterrent System in late 2009. This initiative has since evolved into comprehensive national model for driving suicides to zero among the 80,000 individuals in the behavioral health system in Arizona (view the Culture Card). View the Steering Committee Charter.

Innovative aspects of the program

Historically, mental health providers in the United States have not made suicide prevention and intervention a primary area of focus. Suicide has not been considered core business for three reasons:

  • Fear around the subject experienced by professionals who believe they lack appropriate training, skills and/or supports
  • The myth that suicides are not preventable
  • Treating suicide care as a referral service that is performed by specialty agencies and prevention programs

The Arizona Programmatic Suicide Deterrent System (logic map) has changed the mindset about suicide prevention. It has supported a major culture shift so that now suicide intervention is recognized as a core responsibility of all behavioral health staff. This innovative program has approached suicide prevention from many perspectives:

  • Behavioral health workers' lack of skills/confidence to intervene - Sent all behavioral health staff—more than 3,000—through two-day Applied Suicide Intervention Skills Training (ASIST) identified as a best practice by the Substance Abuse and Mental Health Authority (SAMHSA).
  • Lack of connectedness for those contemplating suicide - Established peer-facilitated attempt survivor support groups, hosted family engagement training and created "100 Meaningful Things To Do."
  • Need for risk identification and stratification - Developed and piloted tools and processes in support of clinical care and intervention

Program framework

ADHS/DBHS and Magellan worked closely to build a community collaborative to tackle this problem. Leaders from many organizations formed a steering committee to provide support and guidance. The steering committee developed a charter with six essential tenets of the Arizona Programmatic Suicide Deterrent System:

  • Providing training for ALL agency staff in suicide intervention and prevention using a national best-practice program-ASIST
  • Ensuring the availability of attempt survivor support groups to supplement the care plan for those at risk of suicide
  • Engaging family and natural supports as to intervene at the outset
  • Developing and implementing standardized approaches to clinical care and intervention, including risk stratification, accessibility and follow-up
  • Engaging/integrating community supports and resources
  • Ensuring culturally appropriate approaches.
  • Developing staff supports.

From 2009-2011, the 12 largest behavioral health service agencies in central Arizona trained their workforce in ASIST. The original goal was to train 2,000 behavioral health professionals. To date, more than 3,000 provider staff members have completed the two-day ASIST. The training has given participants the skills, knowledge and self-confidence to identify and intervene with those at most risk of attempting suicide. The most recent workforce survey supports these findings.

In the program's next stage, its leaders developed support groups for those who have survived a suicide attempt or have persistent suicidal thoughts. Launched in 2011, attempt survivor support groups give participants the resources to help them manage situations when suicidal thoughts occur and to support ongoing recovery. The groups are peer facilitated with clinical support from a licensed clinician. 

A task team developed Family Engagement training in partnership with the National Alliance on Mental Illness. Conducted for providers, the training is now a part of new employee orientation. The task team also created a Family Engagement Packet to help the recipient's "family of choice" better understand the system and provide support.

In 2011, program leaders began the Driving Suicides to Zero initiative, which developed a clinical care and intervention model in partnership with the National Action Alliance for Suicide Prevention. The model's areas of focus include:

  • Definition of levels of risk
  • Best-practice processes for intervention
  • Accessibility and follow-up
  • Engagement/education of professionals and recipients

The initiative leaders reviewed best practices, evidence-based research, existing tools in the community and elsewhere, and every day operations. From this, the group developed screening tools and guidelines for administering and scoring the tools for adults, adolescents, and children. Many of these tools were adapted from the Harvard Medical School Guide to Suicide Assessment and Intervention.

  • Screen - The screen is given at an appointment with the behavioral health practitioner. If an individual has a positive screen, the clinician completes a suicide risk assessment.
  • Risk Assessments - Mainly adapted from the Henry Ford Health System, these tools include a checklist and risk level (low, moderate, or high). Depending upon the risk level, the clinical team can follow suggested intervention based on resources from a clinic decision support tool.

Begun as a pilot, this clinical care and intervention model will launch system wide in 2013. Learn more about this model.

Results

A key achievement is a revolutionary cultural shift—moving the role of helping individuals at risk of suicide from the edge to the center of focus in the behavioral health system. Through community collaboration, intensive education of mental health professionals, dedication of time and resources, and strong commitment, suicide intervention is now a priority. It is viewed as a "core mission" for the largest mental health service providers in central Arizona. But beyond this, mental health providers in the system now believe suicides are preventable—and can be driven to zero.

Progress continues toward our goal of zero suicides. Since 2007, the suicide rate has fallen approximately 41.5 percent for members with serious mental illness and about 50 percent for members in the overall system.

The Arizona Programmatic Suicide Deterrent System was highlighted in the four key priorities for the National Action Alliance for Suicide Prevention in 2012, in "Zero Suicide in Healthcare Systems." The executive committee that selected this initiative from more than 150 ideas included the Secretary of the Army, the U.S. Surgeon General and the directors of NIMH and SAMHSA. Magellan has begun replicating the project with its public sector management contracts in Pennsylvania (five counties) and New York (central region).

To date, the program has received the following awards:

  • Council of State Governments, Western Conference, 2012 Innovations Award winner
  • National Council for Community Behavioral Healthcare, 2012 Award of Excellence in Service Innovation winner
  • International Association of Suicide Prevention, 2011 Lee Award, Best Practices of Suicide Prevention award winner

Suicide Prevention News Archive and Information

Events

Podcasts

Magellan Health Services of Arizona has produced an innovative audio podcast titled, "Suicide Prevention and Intervention in Maricopa County." Discussing this topic are: Katie Ayotte, suicide survivor/mental health advocate; David Covington, vice president of adult and child/youth services, Magellan Health Services of Arizona; Dale Rinard, retired chief executive officer, TERROS; and Allison Kjer, trainer. Access the podcast on iTunes. 

Webinars

In 2001 Henry Ford Health System's division of Behavioral Health Services set out to eliminate suicide among all patients with depression in its HMO network. This goal was a key lever in a broader aim: achieve breakthrough improvement in quality and safety by completely redesigning depression care delivery using the Six Aims and Ten New Rules put forth in the Institute of Medicine report Crossing the Quality Chasm (Committee on Quality of Health Care, 2001).

To communicate this bold vision, the team named the initiative Perfect Depression Care. Today, Henry Ford can report a dramatic and sustained reduction in suicide that is unprecedented in the clinical and quality improvement literature. During this webinar, Justin Coffey, M.D., shares the story of Henry Ford's pursuit of perfection, offering lessons learned along the way and practical strategies for others to begin the pursuit of perfection.

View the webinar featuring Dr. Justin Coffey, chief, Electroconvulsive Therapy Service; assoc. director, Center for Brain Stimulation Therapies; physician champion, Perfect Depression Care in Chronic Disease;Henry Ford Health System, Detroit, MI. 

National Council Magazine - Suicide Prevention, Not Another Life to LoseNational Council Inforgraphic

National CouncilThe September 2012 issue of the National Council for Community Behavioral Healthcare's magazine focuses on suicide prevention and features articles from Magellan Health Services of Arizona, the Arizona Department of Health Services/Division of Behavioral Health Services, and Magellan's provider partners, as well as national experts, such as Thomas Joiner, Ph.D. The issue includes information about the Arizona Programmatic Suicide Deterrent System and provides a comprehensive downloadable suicide prevention infographic about suicide prevention. To learn more, access the issue.

 

 Additional resources:

  • Culture Card: The Diversity and Inclusion (formerly Race and Equity) Suicide Subgroup identified multiple local and national reviewers regarded as subject matter experts per ethnic group to evaluate information within the Culture Card for accuracy and cultural competency.

Media

 

Date

Publication

Story

Dec. 11, 2012

AZTV Channel 13 Morning Scramble

Magellan's Dr. Karen Chaney on Morning Scramble about Suicide Prevention

Dec. 11, 2012                         

KAET-TV, Horizon

Magellan's Dr. Karen Chaney on Horizon about Suicide Prevention

Oct. 5, 2012

KTAR website

David Covington talks about suicide with Pat McMahon (Pat's Portraits)

Sept. 21, 2012

Arizona Republic

David Covington My Turn on Suicide Prevention

Sept. 13, 2012

ABC-TV Channel 15

Suicide Prevention Week

Sept. 11, 2012

AZ TV Morning Scramble

Suicide Prevention Week

April 23, 2012

Mental Health Weekly

Suicide prevention program recognized for service innovation

September 15, 2011

Press Release

Magellan Health Services Receives International Award for Suicide Prevention in Central Arizona

May/June 2011

Behavioral Healthcare Magazine

Dispelling the myths about suicide

November 20, 2010

Arizona Republic (Chandler edition)

Mental-health professionals get suicide-warning ASIST

October 24, 2010

AZCentral.com

An estimated 16 suicides for every 100,000 people yearly (video)

October 14, 2010

HartfordBusiness.com

Magellan Health takes aim at curbing suicides

October 13, 2010

Kansas City Star

Magellan Seeks to Reduce Suicide Deaths Through Groundbreaking Prevention Initiative

October 13, 2010

Press release

Magellan Seeks to Reduce Suicide Deaths Through Groundbreaking Prevention Initiative

Fall 2010

The Magellan

Suicide Prevention and Intervention Initiative seeks to reduce suicide among those most at risk

September 8, 2010

Teleguia en Español

Culmina el 11 de septiembre la Semana Nacional de Prevención de Suicidios (Suicide Prevention Week, article in Spanish)

July 21, 2010

Arizona Republic (East Mesa and Gilbert editions)

My Turn: County working to put focus on suicide prevention (by Dr. Richard Clarke 1.2MB).

May 19, 2010

Prensa Hispana

Buscan frenar suicidios (article in Spanish)

January 13, 2010

Pat McMahon Show

Magellan Suicide Prevention Initiative  (29MB)

December 16, 2009

The Weekly Spark

Suicide Prevention Resource Center (SPRC) newsletter 

December 10, 2009

Arizona Republic

Magellan Health Services alters approach to suicide prevention

November 16, 2009

Provider Weekly

Dr. Joiner Suicide Prevention Webinar 

October 13, 2009

NBC 12 News

Suicide, Crisis Calls and the Economy

October 7, 2009

East Valley Tribune

Changing course of suicide in Maricopa County

September 26, 2009

Arizona Republic - Chandler

Professional help is available for those at risk of suicide

September 10, 2009

Pat McMahon Show

World Suicide Prevention Day (33MB)

 



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