Direct Treatment & Follow-Up

The interventions that make up the primary elements of Zero Suicide are known to work. They all have research-based efficacy. Direct treatment of suicide risk is a core component.

Usual care is disastrous. Dr. Mark Olfson in the July 2017 JAMA Psychiatry carefully describes the very significant suicide risks for individuals in the immediate aftermath of a psychiatric hospitalization and the clear message for the efficacy of universal and continuing interventions and support following discharge. Yet, even when we know the practice works, only about half of US patients receive any outpatient care during the first week after psychiatric hospital discharge, and one-third receive no mental health care during the first month.

Danish researcher Annette Erlangsen’s 2015 Lancet study showed a lower risk of deliberate self-harm and general mortality for those who received psychosocial therapy. In fact, direct treatment of suicide is more effective and cost-efficient than statins are for heart disease prevention (one fatal heart attack is prevented for every 83 people helped for statins versus one self-harm episode prevented for every 44 people treated with psychosocial therapy).

David Jobes has reported 50-80 randomized control trials (RCTs) exist studying the impact of specific interventions on suicidal ideation and behaviors. From these studies he believes we can conclude:

  • There is no documented support for the use of inpatient hospitalization; there are concerns about increased risk for suicide post-discharge
  • Mixed and inconsistent support for use of medication in decreasing suicide risk
  • RCT’s with replicated support:
    • Dialectical Behavior Therapy
    • Cognitive Therapy for Suicide Prevention
    • Collaborative Assessment and Management of Suicidality (CAMS)
    • Non-demand follow-up “caring contact”

Ursula Whiteside, Executive Director of “Now Matters Now,” an on-line video-based program where peers teach evidence-based coping skills to people living with suicidal thoughts, feelings and behavior, offers several slight shifts in healthcare provider behavior that can make a big difference. These include biased-language and additional Dialectical Behavioral Therapy skills such as “opposite action,” “mindfulness of current emotions,” and “paced breathing,” which can be conceptualized as micro-interventions and introduced in as few as 2 to 5 minutes.