Zero Suicide: Working Together to Save Lives

The death of Robin Williams in 2014 was an event that stunned the nation. He was a beloved man who brought laughter to so many people’s lives. His suicide stirred emotions in people as they pondered a myriad of questions.

  • How could someone who had such a full life want to kill himself?”
  • “Did anyone know how much pain he was in? Why didn’t they help him?”
  • “If Robin Williams’ life isn’t worth living, why would someone like me stay alive?”
  • “His death reminds me of when I lost my sister to suicide.”
  • “I have a friend who has been saying he wants to end his life too. How do I help him?”

These are a few examples of what people were saying when they called the National Suicide Prevention Lifeline after Robin Williams death. Calls to the line increased by 40% in the initial week after his death and to remain higher than baseline to this day. Perhaps the only solace in such a great loss was the conversations it sparked and the media’s focus on directing people to resources such as the Lifeline where open conversations about suicide are encouraged. Finally, people knew they had somewhere to turn.

Talking about suicide is a key strategy in its prevention. It’s important that people who are considering suicide are able to find someone with whom they can talk to about their feelings. It is also important that health and behavioral care systems talk about it as well. The Suicide Prevention Resource Center and the National Action Alliance for Suicide Prevention are challenging health and behavioral health care systems to do just this with the Zero Suicide Initiative. Based on the tenet that suicide is preventable, this initiative sets the bold goal of creating systems of care where no one is lost to suicide.

The concept grew from work at the Henry Ford Health System in Michigan where they set out to create a “perfect system” for depression care. It wasn’t long before the question was asked, how will we know if the system is successful and someone responded, “When no one dies by suicide.” This aspirational thinking caused changes in systems at Henry Ford that resulted in an 80% reduction in the suicide rate amongst their health plan members.

The success of the Henry Ford model can be attributed to a systems approach to suicide prevention that requires a commitment to patient safety and to the safety and support of the clinical staff responsible for providing care to those at risk for suicide. The National Action Alliance for Suicide Prevention recognizes seven essential elements for health and behavioral health care systems to adopt in order to close the gaps in care that can lead to an unintentional loss of a life to suicide. The tenets include:

  1. Lead: Create a leadership-driven, safety-oriented culture committed to dramatically reducing suicide among people under care. Include survivors of suicide attempts and suicide loss in leadership and planning roles.
  2. Train: Develop a competent, confident, and caring workforce.
  3. Identify: Systematically identify and assess suicide risk among people receiving care.
  4. Engage: Ensure every individual has a pathway to care that is both timely and adequate to meet his or her needs. Include collaborative safety planning and restriction of lethal means.
  5. Treat: Use effective, evidence-based treatments that directly target suicidal thoughts and behaviors.
  6. Transition: Provide continuous contact and support, especially after acute care.
  7. Improve: Apply a data-driven quality improvement approach to inform system changes that will lead to improved patient outcomes and better care for those at risk.

The timing for the Zero Suicide initiative is perfect as the nation strives to integrate health and behavioral health care systems. Instead of the “don’t ask, don’t tell” mentality that kept life-saving conversations about suicide from happening in these settings in the past, Zero Suicide prompts these systems to see how and where they can integrate practices that can open up conversations about suicide and implement interventions to save lives. And while the initiative is young, decreases in suicide rates from 30%-60% are being seen.

The National Action Alliance has created a toolkit to help those who are committed to Zero Suicide start their work. There are many free tools there to get started. To learn more visit them on the web at

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