Suicide carries grief and mourning and encompasses assumptions, histories, and fantasies. It holds the dialectic of abbreviated narratives and hope-filled storylines for those who survive. 2022 U.S. data from the American Foundation for Suicide Prevention (AFSP) indicates that 1.6 million adults made a suicide attempt and 49,476 adults died by suicide. According to the data, many who survived an attempt did not make further attempts, indicating that prevention efforts lead to positive outcomes. In fact, 94% of adults surveyed believe suicide may be prevented.1 Given the breadth of loss that those impacted by suicide experience, a societal hopefulness around prevention lays the groundwork for treatment services that offer just that. Providing ease of access to care while destigmatizing symptoms through empathic collaboration can cultivate safety for individuals who experience suicidal ideations, as well as for their support networks.
Services for the UnderServed (S:US) is one of the largest community-based health and human services organizations in New York State that works intentionally and daily to right societal imbalances by providing comprehensive and culturally responsive services. Prevention is at the core of the agency’s mission. Goals within preventative services aim to decrease suicidal thoughts and alleviate feelings through skills building, to develop comfortability in disclosing thoughts, and to begin shifting narratives through trauma-informed care. Efficacy is highly dependent upon the approach. S:US’ Certified Community Behavioral Health Clinics (CCBHCs) utilize a multidisciplinary team approach, providing treatment and crisis interventions on-site, in the community, and through telehealth. CCBHCs employ screeners and assessments to determine levels of risk for an individual who experiences suicidal ideations or participates in treatment following an attempt. When a person presents at-risk for suicide, scoring high risk when screened with the Columbia Suicide Severity Scale (C-SSRS)2 or is at risk for suicide by overdose, S:US utilizes the Stanely-Brown Safety Planning Intervention (SPI)3 to identify warning signs, establish coping skills, and name people and community supports to assist during a crisis. SPI encourages exploration of the contributing narrative to ideation or attempt, seeking to understand the complexity of each individual’s story. Weekly multidisciplinary meetings carve out space for discussing complex cases, ensuring a multi-framed lens to act in service of safety and wellness. Case conferences give value to varied perspectives through which an individual in crisis and networks of support determine immediate next steps while fostering hope and connection. Wraparound services respond to the stressors that often trigger suicidal ideation, such as acute stress, isolation, food and housing insecurity, and other social determinants of health.
Many at risk of suicide do not have family or a community and may not seek help in times of crisis due to stigmatization, fear of hospitalization, or hopelessness. S:US identifies support systems as not only family members and friends but also social service providers, community and faith-based organizations, and neighbors. Understanding the makeup of an individual’s support network helps identify untapped resources in suicide prevention. Given that a contributing factor to increased risk for suicide is social isolation, S:US’ efforts rely on the network of care in our Recovery and Treatment programs4 to provide wraparound services to people at risk of suicide. This network can serve as a surrogate support network by connecting individuals with our array of programs geared toward emotional wellness and community integration. Engagement within this network is a critical component of suicide prevention. For example, within CCBHCs, engagement begins with a referral to treatment, identifying emergency contacts and other potential support pathways, then continues through intake such that the moment an individual connects with CCBHCs, staff, and the individual have access to those in a position to assist during times of risk.
Several programs rely on Peer Specialists embedded within. Utilizing their unique lens and approach as a person with lived experience and recognizing the stigma associated with mental illness and substance use that often leads to social isolation, our Peers work with individuals through a Motivational Interviewing lens to invite family and friends into focused recovery efforts. Wraparound by Peers and others decreases the burden of care for family and friends who may simultaneously experience the uncertainty, shame, or fear that creates a barrier to help; these efforts reduce overwhelm as an alternate means of engaging others in suicide prevention. Moreover, Peers conduct outreach for wellness, distribute resources, escort to appointments, and guide individuals toward longer-term treatment as prevention. Additionally, the S:US Brooklyn Clubhouse aims to help individuals integrate into their communities and offers access to the necessary tools to obtain and maintain employment, cultivate meaningful relationships, participate in recreational opportunities for socializing, overcome stigma, and pursue wellness in a supportive and nurturing environment. S:US Care Coordination provides person-centered, community-based, and telehealth services that combine case management, harm reduction, and collaboration with providers; they connect individuals with resources to prevent hospitalization and improve functioning by enhancing community support.
To support individuals who have suffered from suicidal thoughts and feelings or have made an attempt is to also support providers. To best support staff who may also be impacted by suicide/crisis, training plans offer learning on best practices, creative efforts to maneuver complex cases, fortify confidence and competence in crisis response, and enhance empathic response. Internally developed training offers approaches that highlight trauma-informed, person-centered care, understanding that an individual experiences psychic pain during a suicidal crisis. Training not only teaches interventions but engagement strategies that foster exploration of the mass of emotions present in individuals in crisis. Learning how to build upon the larger contextual narratives that contribute to suicide risk is fundamental in prevention, highlighting the nuanced ways in which suicidal thoughts, feelings, and actions emerge and are expressed. Feeling seen and heard in vulnerability and witnessed in the strength that underlies vulnerable moments can be a developed skill. Training efforts that extend beyond the reach of staff encourage nonclinical staff, family members, and friends to learn more about risk factors associated with suicide and resources available in suicide prevention that can help treatment providers increase support for individuals at risk of suicide. A combination of refined, site-specific training and partnerships with external training organizations supports best practices in suicide prevention. CCBHCs participate in the New York State Office of Mental Health’s Zero Suicide (ZS)5 initiative. ZS makes available a range of training courses for all staff types, focusing on communication, lethal means awareness, and evidence-based practices that lead prevention efforts. Beyond CCBHCs, S:US Clubhouse staff are trained in safeTALK6, which emphasizes the importance of recognizing the signs of someone at risk for suicide, communicating with the individual, and getting help, including resources such as the 988 Suicide and Crisis Lifeline. All Recovery and Treatment programs at S:US are invited to participate in safeTALK, recognizing the value of risk workshops, crisis counseling, and more.
Cultivating practices that broaden recovery lenses leads to an attuned ability to respond swiftly and effectively to suicidal crises. Through purposeful collaboration with networks of support, intentional interdisciplinary team engagement, and continued education via research and training, suicide can be prevented. Reducing the incidence of loss for family, friends, and community, in addition to strengthening hopeful narratives with individuals, is a most meaningful venture. S:US aims to destigmatize experiences, deliver interventions that prioritize safety, and seek to decompress the high stress and intensity of a suicidal crisis for staff, individuals, and their larger community of supports.
James Chavez, LCSW, is Regional Director of Treatment & Recovery, and Dani York, LCAT, RDT, is Director of Clinical Support and Enhancement at Services for the UnderServed (S:US).
To learn more about Services for the UnderServed’s approaches to care, visit sus.org, call (212) 633-6900, or email info@sus.org.
References
Suicide statistics | American Foundation for Suicide Prevention
Columbia-Suicide Severity Rating Scale (C-SSRS) | Columbia University Department of Psychiatry
