Utah's suicide rate among highest in U.S., but Intermountain is trying to change that

Healthcare providers are increasingly talking about mental health after the high-profile suicides of celebrity chef Anthony Bourdain and fashion designer Kate Spade. Amid these conversations, Intermountain Healthcare in Salt Lake City partnered with Utah and various community groups on a new Zero Suicide Initiative.

The initiative launched June 25, and it is designed to reduce suicides across Utah, which has one of the highest suicide rates in the U.S.

"Last year, 45,000 people died by suicide in the United States, 630 of them in Utah," Mark Foote, MD, senior medical director of Intermountain Healthcare Behavioral Health, said in a prepared statement. "Suicide is not a new problem. The rate has gone up and down over time, but over the last 15 years, the rate has steadily gone up. This is no longer just a behavioral health problem — this is a public health crisis. We need to engage our entire system and our communities in combatting this horrible problem."

Intermountain officials said the system will specifically focus on improving behavioral care access by increasing the number of patients screened for depression; educating caregivers about how to discuss suicide with patients; helping at-risk individuals get the care they need; and increasing awareness about restricting access to firearms and other lethal means.

Here, Dr. Foote and Lisa Nichols, Intermountain's executive director of community health, discuss the reasoning behind the system's suicide prevention initiative and what makes it unique.

Note: Responses have been lightly edited for length and clarity.

Question: What does the initiative entail?

Lisa Nichols: Zero Suicide is a national framework for health systems on how to address the prevention of suicide within a healthcare system. It's really a comprehensive model that looks at everything from leadership support to ensuring that caregivers across the system are trained and ready. Intermountain does a lot already to address suicide prevention in terms of screening for depression, screening for suicide, creating safety plans. This just ensures we're following our own best practices 100 percent of the time and that we're seeing it as a responsibility throughout the system. For example, we've had six people contact our communications staff talking about suicide, so you really have to prepare everyone throughout the system. The goal is no suicide. Suicide is preventable within the health system. Everyone should be prepared to do it.

Q: What prompted the initiative? Why now?

Mark Foote: The behavioral health clinical program at Intermountain recognizes there's been a growing problem of suicide for several years. Just watching the numbers go up on a national and statewide basis, as well as just recognizing the issue within our system with our patients, [prompted the idea]. In 2014, [employees within] this behavioral health clinical program put together a care process model and decided how to address the issue internally. We developed a screening program, started using a national tool called the Columbia-Suicide Severity Rating Scale, started screening in our primary care offices. We did a systemwide effort at that time, so screening would take place in emergency departments, in inpatient units, in our outpatient clinics [and] our primary care clinics. We did a systemwide education [effort] and tried to get the program going.

Over the last three or four years, we've had moderate success in doing so, but unfortunately, we've continued to see the suicide rate increase. We've worked with the state government and they moved into this Zero Suicide effort maybe a year or so ago, and they had been talking to us about doing the same thing and we want to continue to partner with them. We see this as being not just an internal Intermountain process but really a community and statewide effort. So that's where we dove into this national zero suicide program, and it's given us guidance on how to take our steps to the next level and to continue to work with the state.

LN: As a nonprofit health system, Intermountain is charged with doing community health needs assessments every three years, and we have a collaborative needs assessment process. We do it in conjunction with our state health department and with local health departments. When we did our assessment in 2016, it became clear based on the data and our community input meetings, that the prevention of suicide is very much a priority across the state, and so there was intentionality in looking at the priorities together and creating the same priorities. We really want to bring all resources to the table and be in strong collaboration as we do this work.

Q: What makes Intermountain's initiative unique?

LN: I think historically within health systems, this work has been really within behavioral health, and when it's broadened beyond behavioral health it's seen really to live just in the clinical space. This really says that everyone is engaged in this work. We have a zero-harm initiative, which really is focusing on preventing harm against our caregivers and our patients and for everyone to be responsible for creating a safe environment. As we think about preventing suicide, we're really thinking about it in that much broader way. Everyone is responsible, and it is part of safety for our caregivers and our patients versus something that's just owned by a clinical program or by clinicians.

Q: What does this initiative mean for employees and patients?

LN: I think for everyone it is about hope and resources. It's new. We think about things like diabetes as something that can be prevented, [but] when we talk about suicide people sort of just have this heavy sigh and they think, "Well, there's nothing I can do about that." But that's not an acceptable framework. There is something we can do about it. I think what it means for our employees is they have a toolkit and they have hope and they have resources. We have an emergency department doc[tor] who's engaged in this work who described it exactly that way. [He said:] "It is such a relief to think about some steps I can take as an individual provider that I might even take in our community and that each one of us can take."


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