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Applied Research towards Zero Suicide Healthcare Systems


Jane Pearson, Ph.D.
Division of Services and Intervention Research


The goal of this initiative is to reduce the burden of suicide events in healthcare systems through intervention effectiveness and implementation research. Specifically, this initiative aims to expand the evidence base for the Zero Suicide  project’s practice-to-research efforts, creating a stronger basis for dissemination and large-scale implementation of effective risk detection, intervention, and service delivery strategies for suicide prevention. An effort of the National Action Alliance for Suicide Prevention, Zero Suicide is designed to realize the goal of reducing suicide attempts and deaths by 20% in 5 years and 40% in 10 years. As knowledge about optimal suicide risk detection and treatment continue to advance, this initiative aims to expand the number of learning health care systems in the U.S. that focus on reducing suicide events as part of their business model.


A significant proportion of U.S. suicide decedents have accessed health care within the year of their death. Data from well-defined care systems indicate that 28% (selected state-wide data) to 83% (HMO systems data) of suicide decedents have been seen in healthcare systems within the year. In the Department of Veterans Affairs’ Veterans Health Administration  (VHA), about half of veterans had contact with VHA providers within a month of their death by suicide; similarly, 45% of U.S. military suicide decedents accessed care within 30 days of death. Research from the United Kingdom (UK), VHA, and Henry Ford Health behavioral health care suggests that systematic implementation and continuous improvement of suicide reduction efforts results in fewer suicide events. Building on these findings, the National Action Alliance for Suicide Prevention launched the ‘Zero Suicide ’ effort in 2011 with a review of best practices for reducing suicide events in health care systems. With support from the Substance Abuse and Mental Health Services Administration, the Zero Suicide effort provides technical assistance for best practices to be applied in health care environments (e.g., tools, surveys, screening and intervention information) and training academies for providers. Zero Suicide includes a number of ‘practice-to-science’ suicide prevention efforts that are ripe for empirical investigation. Research support can accelerate rapid testing of system improvement efforts and facilitate analysis of complex data acquired in the course of routine care. Systems of care can benefit from added research expertise to ensure appropriate research designs for greater confidence in evaluating suicide prevention efforts.

This initiative will encourage research in the following areas:

  • Determining deficiencies related to suicide prevention in care systems, using data generated during the course of routine care to identify problems, set quality improvement metrics, and evaluate quality improvements;
  • Improving risk detection (acute or long term) across treatment settings, with appropriate risk monitoring and follow-up care;
  • Testing practical and effective sequenced interventions for initial routine risk mitigation, and later specialized care as needed;
  • Identifying effective ‘upstream’ interventions (taking place before onset of suicidal behavior);
  • Identifying effective service delivery components that work as safety nets to prevent suicidal events; and,
  • Testing service delivery policies and practices that support and maintain Zero Suicide goals and suicide events.

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