NIMH Funds 3 ‘Zero Suicide’ Grants

September 16, 2016 • Science Update

“Zero Suicide” is a commitment, a goal, and a campaign led by the National Action Alliance for Suicide Prevention  and its partners – including NIMH. Recently, NIMH funded three new grants that support the Zero Suicide  commitment to preventing suicide attempts and deaths among individuals receiving treatment within health care systems.

The Zero Suicide campaign seeks to improve health care systems’ ability to identify who is at risk, and to identify and implement effective treatments for at-risk individuals. The campaign is also targeting ways to improve health care systems through provider training and systemic changes.

To support Zero Suicide efforts, NIMH issued a request for applications (RFA) in November 2015.  This RFA was designed to help NIMH fund research

• On practices that lead to safer health care outcomes for at-risk individuals.
• On suicide prevention strategies that would work across a variety of settings. These settings include clinics, emergency departments, hospitals, and primary care programs.
• On the most effective approaches for health care systems. These include: examining a variety of ways to detect suicide risk, the best ways to document risk and follow-up care, effective ways to deliver services, and effective policies and practices.

Today, NIMH is pleased to announce that it is funding three studies submitted during the first round of applications. These studies include:

1. Improving Behavioral Health Care

The first study will be the largest NIH has ever supported on improving the quality of behavioral health care to reduce suicide risk. To look at quality, Dr. Barbara Stanley of Columbia University and her colleagues, will partner with the New York State Office of Mental Health. The researchers will compare quality improvements in suicide prevention practice across 145 outpatient state licensed clinics, which represent 85 New York state agencies, and include 1,490 clinical providers that reach over 80,000 adult clients.

New York has already begun improving suicide prevention efforts in behavioral health care, and this study capitalizes on the state’s roll out plan. The study team will randomly assign some clinics to additional training, tracking, and other infrastructure support, to learn of the best ways to improve suicide screening and safety planning.

Dr. Stanley has been developing and studying safety planning with NIMH grantee Greg Brown within the Veterans Health Care (VA) system. The New York state effort will build on previous VA implementation and training programs. The knowledge gained about the potential benefits of focused implementation efforts will be valuable information for other behavioral health systems planning improvements to reduce suicide risk in their clients.

2. System of Safety (SOS) in Multiple Types of Care Settings

The second study—System of Safety (SOS)—builds off what was learned from the recently completed NIMH ED-SAFE study. ED-SAFE focused on adults who were at risk for suicide and went to an emergency department (ED) for care. The study examined the benefits of improved brief suicide-risk screening, providing outpatient suicide prevention discharge resources, and follow-up telephone counseling for the patient and a significant other. The ED-SAFE, and its follow-up study the ED-SAFE 2, relied on a continuous quality improvement (CQI) approach to implement, monitor, and enhance the interventions during routine clinical care.

Through SOS, Drs. Edwin Boudreaux  and Catarina Kiefe of the University of Massachusetts Medical School will lead a multi-disciplinary team to extend the ED-SAFE CQI approach to additional care settings in the UMass Memorial Health Care  system. SOS will include 6 ED units, 25 inpatient units, and 8 primary care clinics. The researchers estimate that they will reach 310,000 patients aged 12 and older.

Like the ED-SAFE studies, SOS will first examine standard treatment in these settings. Using an innovative phased roll-out study design, SOS will test the effectiveness of its suicide prevention approach while implementing the approach across an entire health care system. Effectiveness will be measured in terms of suicide-risk detection, safety planning, and follow-up care, as well as patient outcomes such as suicide-related events. The researchers will also analyze the cost effectiveness of SOS, to guide future efforts to plan for costs associated with the program’s benefits.

3. ‘Stepped’ Care for Youth Suicide Prevention

The third funded Zero Suicide study focuses on youth at risk for suicidal behavior within the Kaiser Permanente Northwest (KPNW) health system. While the number of effective suicide prevention interventions for adults has grown, there are fewer proven approaches for at-risk youth.  Although there are fewer youth than adults who die by suicide, suicidal thoughts and behaviors often begin in early adolescence, when effective intervention could vastly improve their lives and reduce suicide deaths.

This study, led by Dr. Joan Asarnow of UCLA , and Dr. Greg Clarke of Kaiser Permanente Center for Health Research, will examine outcomes for approximately 300 at-risk youth, ages 12 to 24. The participants will be in one of two groups: either part of the KPNW system’s Zero Suicide practices, or part of a stepped care treatment approach, which includes Zero Suicide practices, but then also matches intensity of treatment to severity of risk.  Researchers will explore which group benefits more in terms of reduced suicide attempts and other patient outcomes. This study builds on prior NIMH-funded research on dialectal behavior therapy for suicidal youth, cognitive-behavioral family-centered treatment for youths after a suicide attempt, and internet cognitive behavior therapy for individuals with depression.  The KPNW effort will also include a cost effectiveness component.

Future Research

A second round of requests for applications for Zero Suicide is set for November, 2016. NIMH hopes to fund additional studies in order to learn more about health care practices that reduce suicide risk.