Zero Suicide

DMH aims to instill effective suicide prevention strategies across the DMH and larger behavioral health system. The Division of Clinical and Professional Services is responsible for spearheading this initiative.

DMH has embraced Zero Suicide as the organizing structure for its suicide prevention work.  Zero Suicide is an evidence based continuous quality improvement framework for instituting safer suicide practices within healthcare systems.  The Zero Suicide initiative is necessarily predicated on a culture of care that is person-centered and family-focused, culturally responsive, trauma-informed and recovery-focused. With this in mind, the DMH Suicide Prevention Steering Committee (SPSC) is comprised of DMH staff from all five geographic services areas, child youth and family division, forensic services, inpatient, outpatient, and community services, recovery services, and quality management as well as community consultants with lived experience as attempt survivors.

The Zero Suicide initiative is comprised of three core components which constitute the critical and necessary elements of any quality improvement initiative:

1. leadership engagement,
2. training, and
3. the use of data to provide continuous feedback.

DMH leadership, beginning with the Commissioner, emphasizes the importance of addressing suicidality effectively throughout DMH operations, the MA behavioral health system, and the larger health care system across the Commonwealth. DMH’s Learning and Development Office has instituted mandatory suicide prevention training in Question, Persuade, and Refer (QPR) for all DMH employees and supports the delivery of role-specific trainings in suicide prevention evidence-based practices, including the assessment of suicide risk, safety planning, counseling around access to lethal means, caring contacts, and treatment of suicidality. Regular monitoring of DMH data regarding adherence to DMH protocols and incidence of suicide attempts and suicide deaths is used to inform DMH internal operations and suicide prevention work.

The Zero Suicide initiative promotes four core service-focused components:

1. Identify – recognize signs of potential risk and utilize evidence-based screening strategies.
2. Engage – consistently outreach and engage individuals in collaborative care.
3. Treat – provide evidence-based suicide-specific treatment.
4. Transition – offer proactive and frequent support to individuals through transitions.

These 4 service-focused principles of safer suicide care are consistent with the DMH mission and service framework.  DMH, in concert with the recently updated Joint Commission safety standards, promotes the use of evidence-based screening, assessment, safety planning, transitions support, and treatment planning within DMH-operated and DMH-contracted programs. 

Massachusetts Suicide Prevention

Suicide prevention efforts in Massachusetts are funded largely through a separate line item in the state budget for the Massachusetts Suicide Prevention Program (MSPP) at the Department of Public Health (DPH). https://www.mass.gov/suicide-prevention-program The MSPP funding supports suicide prevention services targeting veterans, older adults, college and university students, youth and young adults, mid-life adults, LGBQT youth, and transgender people. Since 2012, the MSSP at DPH and DMH have forged a strong collaborative relationship, particularly around the dissemination of Zero Suicide to Massachusetts’ health care systems.

Alternatives to Suicide: Integral to Massachusetts suicide prevention efforts is the inclusion of people directly affected by suicide, including loss survivors, attempt survivors, and their family members in all activities as leaders and participants in the work of the state and regional coalitions, statewide initiatives across the state and within DMH. MSPP and DMH have partnered to support the development, dissemination, and implementation of Alternatives to Suicide, a peer-to-peer support group for people contemplating suicide, which was developed by the Wildflower Alliance, a DMH-funded Recovery Learning Community. 

Governor’s Challenge to Prevent Suicide Among SMVF:

DMH partners with the Executive Office of Veteran’s Services and MSPP to address Suicide Prevention of Service Members, Veterans, and their Families (SMVF).  The Commonwealth’s work under the auspices of the Governor’s Challenge has brought together community, state and federal stakeholders working together to reduce suicide among SMVF.  Consistent with a Zero Suicide framework this work has focused on training healthcare providers and first responders in military culture, engaging SMVF, screening for suicide, increasing lethal means safety and safety planning.  

Suicide Prevention with Tribal Communities

DMH staff have fostered a connection with staff at Indian Health Services (IHS) and Health and Human Services (HHS) of the Mashpee Wampanoag Tribe since 2017 initially through the National Strategy for Suicide Prevention (NSSP) grant. Working in close collaboration with Massachusetts Suicide Prevention Program (MSPP) leadership, DMH staff have provided technical assistance and support to IHS and HHS. IHS took part in the Cape and Islands Zero Suicide Learning Collaborative and have incorporated evidence-based strategies for safer suicide care into their clinic.