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6 TFAH • WBT • PaininTheNation.org THE ZERO SUICIDE MODEL The Zero Suicide Model is a comprehensive suicide prevention approach that rests on the foundational belief that all suicides are preventable. 34 Launched by the National Action Alliance for Suicide Prevention and supported by SAMHSA, the model uses a framework of screening, treatment and support to integrate suicide prevention into primary and behavioral healthcare. The Zero Suicide initiative was modeled on practices utilized by several healthcare systems that showed significant reductions in suicides for patients in their care, including the Henry Ford Health System in Detroit. 35,36 At Henry Ford, primary care doctors screen every patient during every visit with two questions: 1. How often have you felt down in the past two weeks? 2. How often have you felt little pleasure in doing things? Patients with high scores are asked additional questions about sleep disturbances, changes in appetite and thoughts of hurting oneself. Patients who indicate a problem are assigned to appropriate care, which may include cognitive behavioral therapy, medication, group counseling or, if necessary, hospitalization. 37 The Zero Suicide protocol includes other practices, such as: l Testing new behavioral health models, such as drop-in group therapy and same-day psychiatric visits; l Developing firearm removal policies with patients and their families to help reduce access to means of suicide; and l Assuming every patient with a history of behavioral health needs is a suicide risk. 38 Implementation of this approach has had no negative impact on the division's financial health. In fact, the Zero Suicide approach can even save health systems money. Nashville-based Centerstone, a behavioral healthcare organization that implemented the model, has reaped annual cost savings of more than $400,000 from the program. 40 SAMHSA is now providing federal funding to organizations—including community-based primary care and behavioral health organizations and emergency rooms—to implement the Zero Suicide model in health systems. 41 The program has achieved dramatic results—an 80 percent reduction in suicides among Henry Ford's HMO members. This reduction has been maintained for over a decade, even as the overall U.S. suicide rate has increased. 39

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