Becky Stoll (USA)

03 Stoll01 USIn 2014, Becky Stoll, LCSW, was Vice President for Crisis and Disaster Management at Centerstone, one of the largest non-profit community mental health centers in the US, when she traveled to participate in the inaugural Zero Suicide International class in Oxford. She is one of the few to attend every summit, including Atlanta, Sydney and Rotterdam.

In 2015, Ms. Stoll and the Centerstone program was featured in US News and World Report in “Strides in Suicide Prevention: Efforts are growing from every direction.” In that article, she said her system launched its program about 20 months previously.

Centerstone’s patients are treated for conditions such as anxiety, bipolar disorder and schizophrenia, she notes, placing them at a higher risk for suicide compared to the general population.

The difference starts with the screening process, where the patient is evaluated using the Columbia Suicide Severity Rating Scale – a highly regarded assessment tool – which is embedded into the patient’s electronic health record. If he or she is determined to be at high risk, that sets off a chain of responses.

“A box pops up and says, ‘X is recommended to go into the suicidal pathway,'” Stoll says. An education sheet, vetted by suicide survivors, lets patients know they’ve been identified as high-risk and should receive stepped-up care. “You’re in a very fragile state right now,” patients are told. “We really care about you.” Clinicians plan to see these patients more frequently and pull their support systems – families and loved ones – into the care team.

Patients are asked to call if they can’t show up for an appointment, because otherwise a staff member will worry. If a therapist can’t reach a no-show patient, a quick entry in his or her electronic health record sends a prompt to the system’s 24/7 crisis call center. Call center staff will monitor the situation, first by trying to reach the patient directly, then going through the emergency contacts – whatever it takes to locate the patient.

Often, people have just forgotten their appointments, Stoll says. “But we’ve probably had a dozen rescues where people were actually suicidal, and we had to send help out to them.”

Since Centerstone started Zero Suicide, they’ve seen results. “Twenty months ago we were at 3.1 [suicides] per 10,000 people. And 20 months later we had that at 1.1.” There’s still a lot of work to do, Stoll says. Among other efforts, they’re planning programs to equip patients in need with smartphones and provide Fitbits – wearable technology to motivate users to be more active – to others to help curb depression.