1

Big Hairy Audacious Goals (BHAGs)

• Smallpox was eradicated in 1980. • The five-year survival rates in 1975 of

certain forms of cancer, such as breast, prostate, and colorectal, were 75%, 69%, and 51%, respectively. In 2007, survival rates increased to 90%, 100%, and 67%, respectively.

• And the incidence of polio has gone down dramatically since 1988, when over 350,000 cases were reported. In 2014, that number plummeted to only 359 reported cases, a 99% decrease.

2

“Over the decades, individual [mental

health] clinicians have made heroic efforts to

save lives… but systems of care have

done very little.”

MYTH: HEALTHCARE CANNOT MAKE A DENT

MYTH: HEALTHCARE CANNOT MAKE A DENT

REALITY: 80% OF INDIVIDUALS WHO DIE OF SUICIDE WERE SEEN IN THE HEALTHCARE SYSTEM IN THE PRIOR 12 MONTHS

MYTH: WE DON’T SEE THOSE AT GREATEST RISK

MYTH: THERE’S JUST NOT MUCH WE CAN DO TO STOP SOMEONE “TRULY INTENT”

11

Prominent suicidologists, argued successfully, albeit erroneously, that this is not a healthcare issue. They kept suicide out of the mental health Bible, the DSM, stating, “suicide is, by definition, not a disease, but a death that is caused by a self-inflicted intentional action or behavior.”

Not a Healthcare Issue?

Many/Most Suicides Tragically Inevitable5

1

34

2

Some Suicides Tragically Inevitable

Some Suicides Preventable, But Only in Advance of Acute Risk

Every Suicide Preventable, But Only in Advance of Acute Risk

Suicide is preventable… but… Likert

Every Suicide Preventable, Even Up Until the Last Moment

BIG IDEA #1REJECT THE MYTHS AND ASPIRE FOR ZERO

Suicide is a CHOICE

No light; but rather darkness visibleWhere peace and rest can never dwell, hope never comes

That comes to all, but torture without end

The Physical Pain Physiological Response

People have succumbed when all their strength was fully,

completely gone.

Not a Choice

Someone who died by hanging with their hands bound behind their back and feet tied together was probably a murder, not a suicide.

A.TrueB.False

BIG IDEA #2START YOUR GOAL FROM THE OTHER END

BIG IDEA #3INCLUDE LIVEDEXP IN YOUR DESIGN PROCESS, LEADERSHIP AND DELIVERY

1987

1990

1997

2005

2011

2014

2016

2017

2017

BIG IDEA #4TAKE THE LEAD & JOIN A GLOBAL LEARNING COMMUNITY

We are Sparta!

WE CANNOT DO THIS ALONE

EDUCATIONBuilding the capacity for change through

knowledge exchange and training

EDUCATION

Errors Are Costly

1986

CROSSING THE QUALITY CHASM

Better Care = Patient ExperienceSafe EffectivePatient-Centered TimelyEfficient Equitable

Triple Aim of Healthcare ImprovementBetter Health Better Care Better Value

1986

Don Berwick (USA)

Errors Are Costly

19861986

Don Berwick (USA)

1996

Going to War with Suicide

David Litts

(USA)“[At the start] there was a lot of debate about whether or not it was even possible to reduce suicide through this type of an effort,” according to David Litts. “A lot of people, including mental health practitioners, were skeptical. But over a six-year period, the suicide rate dropped by one-third.”

US Air Force Initiative

2001

What if care were perfect?

20012001

Ed Coffey (USA)

100

80

60

40

20

02000 2010

2004

What was actually

different?

Henry Ford Clinical ProtocolPackage of Discrete Research-based Interventions Known to Be EffectiveRoutine Screening & Assessment

PsychosocialTreatment

Collaborative Safety Planning

Follow-Up

2004

Justin Coffey (USA)

Zero Suicide Healthcare that believes no one should die alone and in despair. Healthcare that’s safer.

ZeroSuicide.org for global learning community. ZeroSuicide.com for fidelity toolkit/resources.

A Simple Emergency Room Intervention Can Help Cut Suicide Risk

Standard Crisis Care

2005

John Draper(USA)

The Clinician

Viewpoint

20092009

David Covington

(USA)Magellan Health Surveys 30,000 in Workforce

Lived Expertise

Voice

2010

Eduardo Vega(USA)

REDESIGNMoving beyond best practice to innovative

designs based on novel concepts

EDUCATION REDESIGN

2010“Over the decades, individual [mental health] clinicians

have made heroic efforts to save

lives… but systems of care have done

very little.”

Forgotten Patients

Richard McKeon (USA)

Gotta Have a Model

2011

Suicide Care in Systems Framework

Michael Hogan (USA)

2011

2012

Systems Models

2012

Nav Kapur (UK)

2013

Website & Seven

Elements

2013

Julie Goldstein

(USA)

Implementation Academies

2013

Julie Goldstein

(USA)

MOVEMENTUnifying the industry around the common

cause of improving health care for all

EDUCATION REDESIGN MOVEMENT

2014

1st

Int’l ZS Summit

Jerry Reed (USA)

Oxford

2015

A Whole Nation

Discussion

2015

Norman Lamb, MP

(UK)Suicide Prevention in Ontario Hospitals

2015

2nd

Int’l ZS Summit

Jo Smith (UK)

SEA #56

Michael Hogan (USA)

2016

2017

ZERO APPLIED

Sydney

From International Declaration to Local Action

3rd

Int’l ZS Summit

2017

Sue Murray

(Australia)

2018

London

1st

Int’l Crisis Summit

2018

Caroline Dollery

(UK)

2018Rotterdam

4th

Int’l ZS Summit

2018

Jan Mokkenstorm (Netherlands)

FULL SCALEChanging mainstream practice standards

by ensuring widespread deployment

EDUCATION REDESIGN MOVEMENT FULL SCALE

2013

US News & World Report

2013

Becky Stoll

(USA)

2014

SUPRA-NET Care &

Community

2014

Jan Mokkenstorm (Netherlands)

4th

Int’l ZS Summit

2017

Jan Mokkenstorm (Netherlands)

October 2017

2015

Social Movement

2015

Joe Rafferty

(UK)

2017

Joe Rafferty

(UK)

2016

Speed to Market

Gold Coast Health

2016

Kathryn Turner

(Australia)

2017

Gaining Momentum

2017

Ian Dawe (Canada) Suicide Prevention in

Ontario Hospitals

2018

MD & MBA

2018

Steve Duffy

(N. Zealand)

2018

NIMH 5-Year Grant

Brian Ahmedani

(USA)

JENNA HEISETexas, USA

JAN ULRICHKentucky, USA

VIRNA LITTLENew York, USA

FRED MESERVEY New York, USA

PAUL SCHYVEJoint Commission,

USA

DAVID JOBESCatholic University,

USA

KATE COMTOISSeattle, USA

THOMAS JOINERFlorida State

University, USA

CHRIS DAMLEPhoenix, Arizona

GREGOR HENDERSONLondon, UK

HELEN GARNHAMLondon, UK

PAUL YIPHong Kong, China

ADRIAN JAMESExeter, UK

SALLY SPENCER-THOMAS

Denver, USA

KEVIN HINESAtlanta, USA

URSULA WHITESIDESeattle, USA

CrisisNow.com

washdc201802

england202005

ZeroSuicide.org

zerosuicideinternational

For quality,

NASABerwick went to

davidwcovington.com