Researchers have a proven prescription for reducing suicide rates

In a new multistate study, the Zero Suicide Model reduced suicide rates by 25%

Nearly every person who dies by suicide visits a doctor’s office within a year of their death. A new body of research suggests that by adopting a specific protocol, health systems can reduce suicide rates among those patients by 25%.

Researchers say the findings support comprehensive widespread adoption of a method called the Zero Suicide (ZS) Model, as suicide remains among the leading causes of death in the United States. In 2022, 49,000 people died by suicide in the U.S. Suicide was the second leading cause of death among people ages 10 to 14 and 20 to 34, and it was the third leading cause among those 15 to 19.

Over the course of 8 years, researchers at Henry Ford Health and Kaiser Permanente examined implementation of the ZS Model in primary care and behavioral health settings. Previously, the method had only been studied at Henry Ford Health, the Detroit-based health system where the model was founded in 2001. 

“We’ve seen over the past 23 years how effective this model can be. Some years we literally have zero suicides within our patient population,” said Brian K. Ahmedani, PhD, lead author of the study and director of research for Behavioral Health Services at Henry Ford Health. “As health systems across the country and around the world begin to adopt this strategy, it was important to prove its effectiveness beyond our health system.”

Data shows more than 80% of people who die by suicide and more than 90% of people who attempt suicide visit a doctor’s office in the months and weeks leading up to their death.

“Prior to the Zero Suicide Model, health systems may have lacked organized programs to identify and address suicide risk. These studies support the implementation of the Zero Suicide Model and reinforce the need for policies to support widespread, comprehensive implementation,” said coauthor Gregory E. Simon, MD, MPH, psychiatrist and senior investigator at Kaiser Permanente Washington Health Research Institute.

The ZS Model starts with suicide risk screening through a questionnaire that patients fill out before they see their doctor, and providers immediately evaluate. If a patient says they have frequent thoughts about self-harm, they are further assessed for suicide risk. Those at high-risk for suicide work with a specialized member of the care team to create a safety plan that covers:

• Who they can call if they’re in distress
• Cognitive tools for reducing suicidal thoughts
• What they can do to try to make their home environment safe

Then, the patient is referred to an outpatient behavioral health provider for psychotherapy focused on suicide prevention.

The ZS Model Implementation Study, published in JAMA Network Open, examined implementation in behavioral health clinics at 5 Kaiser Permanente health systems in California, Oregon, Washington, and Colorado, as well as Henry Ford Health locations in Michigan.

Embedded researchers within each system collaborated with outpatient behavioral health care providers to document components of the ZS Method incorporated into the care of more than 300,000 patients per month over the age of 13 from 2012 to 2019.

The researchers tracked suicide attempts and suicide deaths after implementation and found rates dropped by as much as 25%.

“These statistics are incredibly significant, particularly when you consider patients who engage with behavioral health specialists are at a higher risk for suicide than those who visit a general practitioner,” Ahmedani said.  

In a concurrent study with findings published last fall, researchers examined ZS Model implementation among more than 475,000 patients in 19 primary care practices within the Kaiser Permanente system in Washington state. Again, the rate of suicide attempts was 25% lower with the ZS Model approach.

“‘Zero Suicide’ may seem like an impossible goal, but we believe we should strive every day to try to prevent suicide among our patients,” Ahmedani said. “This is the best evidence yet that we have the tools to recognize those in distress, intervene, and help them change course.”

This was adapted from a Henry Ford Health news release.​​​​