«Zero Suicide» – A model for reducing suicide in United States behavioral healthcare


  • Christa D. Labouliere
  • Prabu Vasan
  • Anni Kramer
  • Gregory Brown
  • Kelly Green
  • Jamie Kammer
  • Molly Finnerty
  • Barbara Stanley




Suicide is a serious public health concern in the US, especially
for those served in outpatient behavioral health. Over the past
decade, there has been a dramatic increase in US suicide rates,
and a significant proportion of those dying by or attempting
suicide were treated in outpatient behavioral healthcare within
the prior year. In response, the US Action Alliance released the
National Strategy for Suicide Prevention in 2012, a key tenet of
which is the «Zero Suicide» (ZS) model. ZS provides resources
for administrators and providers to create a systematic approach
to quality improvement for suicide prevention in healthcare
systems via seven essential elements (Lead, Train, Identify,
Engage, Treat, Transition, Improve). In this paper, we describe
the ZS model, as well as our operationalization of the model in
an NIMH-funded study in ~170 free-standing New York State
outpatient behavioral health clinics, serving >80 000 patients.
This study is the largest implementation and evaluation of the
ZS approach ever conducted in outpatient behavioral health.
Evaluation of ZS implementation in «real-world» clinical settings
will provide crucial insight regarding broader dissemination and
inform how to best adopt empirically-supported care for suicidal
patients in outpatient behavioral health, thereby reducing tragic
and preventable loss of life.

Selvmord er et alvorlig folkehelseproblem i USA, spesielt for de
som mottar poliklinisk behandling i psykisk helsevern. Det har
vært en dramatisk økning i amerikanske selvmordsrater det siste
tiåret, og en signifikant andel av de som forsøker å ta eller tar sitt
eget liv mottok poliklinisk behandling i psykisk helsevern innenfor
det samme året. Som mottiltak publiserte The US Action Alliance
en nasjonal strategi for selvmordsforebygging i 2012 med et
grunnprinsipp om nullvisjon, eller Zero Suicide på engelsk (ZS).
Nullvisjonsmodellen tilbyr hjelpemidler for helsearbeidere for å
skape en systematisk tilnærming til kvalitetsfor bedring i selvmordsforebyggingi helsevesenets systemer gjennom syv essensielle
elementer (lede, lære opp, identifisere, engasjere, behandle, følge
opp, forbedre). I denne artikkelen vil vi beskrive nullvisjonsmodellen,
samt vår implementering av modellen i en studie finansiert
av NIMH (Nasjonalt institutt for psykisk helse i USA) i omtrent 170
frittstående institusjoner for psykisk helsevern i delstaten New York,
som til sammen omfattet over 80 000 pasienter. Denne studien
er den største implementeringen og evalueringen av nullvisjonstilnærmingensom noensinne er blitt gjennomført i psykiatriske
poliklinikker. Å evaluere en slik nullvisjonsstrategi i kliniske settinger
kan gi viktig kunnskap til bruk i bredere implementering og gi
mer kunnskap om hvordan innføre kunnskapsbasert poliklinisk
behandling for suicidale pasienter i psykisk helsevern, og slik
redusere forekomsten av tragiske dødsfall.


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