Implementing Zero Suicide

Zero Suicide helps local public health departments create a “no wrong door” approach. Regardless of why someone enters the system (e.g., HIV testing, home-based physical therapy, etc.), screening helps identify individuals with suicide risk. Collaborative safety planning and lethal means counseling provides important life-saving, brief interventions. And intentional and timely care transitions support safety during high risk times, and connect individuals to local treatment providers.  

While the LPH generally does not provide suicide-specific treatment, staff can promote safety and engagement with community partners using the Zero Suicide framework. 

Screening and Assessment at Healthcare Visits

In public health, patient visits begin with screening that check important vital signs. Suicide risk screening is no different. Evidence-based tools, such as the Columbia Suicide Severity Rating Scale, were developed to help healthcare providers quickly identify individuals with suicide risk.  

It is best practice to follow a positive suicide risk screening with a thorough clinical assessment to determine follow-up and formulate a plan care of appropriate to the individual’s level of suicide risk.  While many LPH departments may not have the capacity or trained staff to conduct a suicide risk assessment, they can provide a warm hand-off to partners in the community who can provide the necessary follow-up and care.

Collaborative Safety Planning and Lethal Means Safety

Anyone with appropriate training can support individuals with suicide risk by assisting them to create a collaborative safety plan that includes lethal means counseling.  This includes nurses, care coordinators, peer support, home visitors, and outreach workers. Collaborative safety planning and lethal means counseling are two important suicide interventions that have been demonstrated to either reduce suicide thoughts and behaviors or increase the likelihood that individuals will engage with treatment when referrals are made to providers in the community. 

Supportive Care Transitions and Referrals to Community Providers

The Zero Suicide framework includes the implementation of care transition strategies to support safety as individuals with suicide risk move from one level of care to the next – times when they are most vulnerable. When referring clients with suicide risk to a community partner, this may include the period between screening and assessment, or the time before individuals attend their first appointment with a provider.  

Local public health departments are typically very good at building relationships with community partners, but workforce challenges and other logistical barriers experienced by the client sometimes contribute to individuals not following up with referrals or a lack of communication between agencies means our staff are often not aware of whether or not individuals were able to connect with help.  

Examples of care transition strategies that can be implemented in LPH include a warm hand-off to a treatment provider, non-demand caring contacts, community outreach from a peer support specialist, or a follow-up phone call from a care coordinator after a positive suicide risk screen.  Research has demonstrated that these types of strategies support suicide safety and engagement with treatment providers.

Continuous Quality Improvement

Zero Suicide is a continuous quality improvement approach to transform the way healthcare identifies and supports individuals with suicide risk – in their systems and in the community.  Zero Suicide is a data-driven, systems transformation approach to improve safer suicide care. It is an aspirational goal because simply – there is no other acceptable number for suicide deaths.  

In addition, local public health departments are critical partners in community-level data collection and fatality reviews.  Both are an important to effective Zero Suicide implementation.

Supporting the Workforce

Caring for individuals at risk of suicide can negatively affect local public health workers, contributing to burnout, workforce turnover, and lower job satisfaction. Supporting worker wellness, therefore, requires systems-level changes rather than relying solely on individual providers. Standardized policies and protocols, combined with evidence-based practices, can reduce the emotional load of care by clarifying roles, responses, and available supports. These structures also increase staff competency and confidence in identifying and responding to suicide risk, strengthening both workforce wellbeing and the quality of care.