The Zero Suicide in Texas Program helped more than 1,200 youth receive mental health services
In 2014, suicide was the second leading cause of death among individuals aged 10–34 years in the United States.1 According to Youth Risk Behavior Surveillance System data from 2013, 17% of high school students had seriously considered suicide, and 8% had attempted to take their own life in the past year.2 In 2013, among adolescents aged 12–17 years, 10.7% reported having had a major depressive episode (MDE) in the past 12 months.3
In Texas, there were 443 suicide deaths among Texas youth and young adults aged 15–24 years in 2014.1 To address suicide and suicide prevention in Texas, in October 2013, the Texas Department of State Health Services (DSHS) launched the Zero Suicide in Texas Program (ZEST) via a 3-year cooperative agreement from the Substance Abuse and Mental Health Services Administration (SAMHSA). This initiative targets Texas youth aged 10–24 years with serious emotional disturbance or severe mental illness.4 ZEST strives to implement suicide prevention activities at the organizational, local, and state levels in an effort to reduce deaths by suicide and suicide attempts among youth in Texas. Additionally, ZEST focuses on improving the identification of treatment and support services for high-risk youth by creating Suicide Safe Care Centers within the public mental health system; expanding and coordinating best practice suicide prevention activities to create Suicide Safe Care Communities; and establishing collaborative suicide prevention programming at the state and local levels to create a Suicide Safe Care State. Twenty-three Suicide Safe Care Centers covering 148 counties across the state have partnered with DSHS to utilize best practices to minimize the risk of suicide for children, adolescents, and adults accessing services from the organization.5 These centers, which work within the mental health system, extend their reach to local organizations and community partners that serve youth through suicide prevention trainings and activities to create Suicide Safe Care Communities. To create a Suicide Safe Care State, research-informed communication efforts were designed and implemented by changing knowledge, attitudes, and behaviors to prevent suicide.6
Additionally, the establishment of collaborative efforts among organizations and community partners that serve youth has contributed to the implementation of ZEST across Texas. The Texas Suicide Prevention Council, which includes over 50 statewide and community-level groups, allows for coordinated suicide prevention activities to be implemented across the state. In addition to DSHS, key partners include: Mental Health America of Texas (MHAT), Texas Institute for Excellence in Mental Health (TIEMH) at the University of Texas at Austin, and the Denton County MHMR Center.6 MHAT coordinates trainings, social media, special events, and community-based efforts. TIEMH supports local implementation of ZEST and is the academic link that provides evaluation and quality management support, data analysis, and coordination of train-the-trainer for clinical staff at the community mental health centers. Denton County MHMR serves as the pilot community site for ZEST implementation, tests all the zero suicide model ideas and best practices, and conducts data collection for evaluation efforts. Between October 2013 and March 2016, at the Denton County MHMR Center, 1,425 adolescents or young adults (aged 10–24 years) were screened using the Columbia Suicide Severity Rating Scale. Among those who were screened, 95.6% (n=1,362) were referred for mental health or other services. Following screening, the most frequent referrals were to the public mental health system (47.2%), psychiatric hospitalization (28.6%), and private mental health providers (24.7%). As a result of the referrals, 94.5% (n=1,287) of individuals received management mental health services within 30 days of referral, with case management being the most common follow-up service received.7
Over the course of implementing the Zero Suicide in Texas Program, the program has expanded its reach outside of Denton County to 148 out of 254 Texas counties.7 To better meet the needs of the target population served, the program has learned that it is possible to build best practices into the current work flow of the mental health system and develop metrics to evaluate these practices. Moving forward, the program plans to work on the sustainability of their current partner sites so they can continue to operate after funding has ended. As a result of the grant, the program will work to collect data metrics such as suicide attempts and suicide deaths at the agency, county, and state levels. Furthermore, the program will continue to expand and define best practices to create a “gold standard” of care.
Zero Suicide in Texas
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