Depression care program eliminates suicide

The program, chronicled in an article in the Journal of the American Medical Association, was created by the Behavioral Health Services division of Henry Ford Health System in 2001.

The rate of suicide in Henry Ford's patient population decreased by 75 percent from 89 per 100,000 patients to 22 per 100,000 in the first four years of the program's implementation, significantly lower than the annual rates for suicides in similar patient populations. For the last two and a half years, that rate has been zero per 100,000. This remarkably low rate of patient suicide stands in marked contrast to an expected rate of 230 per 100,000 as reported from scientific research.

"The encouraging results of the initiative suggest that this care model can be highly effective for achieving and sustaining breakthrough quality improvement in mental health care," says C. Edward Coffey, M.D., Henry Ford Health System vice president and CEO of Behavioral Health Services.

"Pursuing perfection is no longer a project or initiative for our team but a principle driving force embedded in the fabric of our clinical care."

Some of the performance improvements in the program include:

• Establish a consumer advisory panel to help with the design of the program.
• Establish a protocol to assign patients into one of three levels of risk for suicide, each of which requires specific intervention.
• Provide training for all psychotherapists to develop competency in Cognitive Behavior Therapy.
• Implement a protocol for having patients remove weapons from the home.
• Establish three means of access for patients: drop-in group medication appointments, advanced (same-day) access to care or support and e-mail visits.
• Develop a website for patients to educate and assist patients.
• Require staff to complete a suicide prevention course.
• Set up a system for staff members to check in on patients by phone.
• Partner and educate the patient's family members.

The National Institute for Mental Health estimates more than 33,000 people die by suicide each year in the United States. More than 90 percent of people who kill themselves have a diagnosable mental disorder, most commonly a depressive disorder or a substance abuse disorder.

Risk factors for suicide include a prior suicide attempt; family history of mental disorder, substance abuse or suicide; family violence, including physical or sexual abuse; firearms in the home, the method used in more than half of suicides; and incarceration.

Henry Ford's Perfect Depression Care program has been nationally recognized and awarded the Joint Commission's Ernest Amory Codman Award, a health care award that recognizes excellence in performance measurement.

Henry Ford Health System's Behavioral Health Services provides a full continuum of mental health and substance abuse services through a large integrated delivery system of two hospitals, 10 clinics, and more than 500 employees that serves southeastern Michigan and adjacent states. Through its department of psychiatry, Behavioral Health Services is also engaged in a large academic enterprise, which includes numerous education, training, and research programs.