Zero Suicide Model Implementation and Suicide Attempt Rates in Outpatient Mental Health Care

Ahmedani, B. K., et al. (2025).

JAMA Network Open, 8(4), e253721.

https://doi.org/10.1001/jamanetworkopen.2025.3721

Key Points

Question  Is implementation of the Zero Suicide model in outpatient mental health care associated with reductions in suicide attempts?

Findings  This quality improvement study of 55 354 to 451 837 individuals per month aged 13 years or older found that implementation of the Zero Suicide model was associated with a reduction in suicide attempt rates in 3 of 4 health systems, while the fourth system experienced a lower sustained rate. Two systems that implemented the model before the observation period maintained low or declining rates.

Meaning  Findings from this study support implementation of the Zero Suicide model in outpatient mental health care.

Abstract (partial) 

Importance  Suicide is a major public health concern, and as most individuals have contact with health care practitioners before suicide, health systems are essential for suicide prevention. The Zero Suicide (ZS) model is the recommended approach for suicide prevention in health systems, but more evidence is needed to support its widespread adoption.

Objective  To examine suicide attempt rates associated with implementation of the ZS model in outpatient mental health care within 6 US health systems.

Conclusions and Relevance  In this quality improvement study, ZS model implementation was associated with a reduction in suicide attempt rates among patients accessing outpatient mental health care at most study sites, which supports widespread efforts to implement the ZS model in these settings within US health systems.

The study is linked above.

Here are some thoughts:

This study examined the impact of the Zero Suicide (ZS) model on suicide attempt rates within outpatient mental health care settings across six U.S. health systems.  The ZS model, a recommended approach for suicide prevention in health systems, was implemented in four of the health systems during the study period, while the other two had already adopted the model prior to the study.    

The study found that the implementation of the ZS model was associated with a reduction in suicide attempt rates in three of the four health systems that implemented the model during the study period.  The fourth system showed a sustained lower rate of suicide attempts following implementation.  The two health systems that had implemented the ZS model before the study period maintained low or declining rates of suicide attempts.    

This research is important for psychologists because it provides evidence supporting the effectiveness of the ZS model in reducing suicide attempts in outpatient mental health care settings.  Given that suicide is a major public health concern and that a large proportion of individuals who attempt suicide have had contact with the health system prior to their attempt, the study's findings highlight the critical role of health systems in suicide prevention.  The results of this study support the implementation of the ZS model in outpatient mental health care.

Zero Suicide in Health Care

Published on Dec 15, 2014

If you ask people what you should do to help a person who may be suicidal, most—if not all—would say that person should be referred to a health care professional or organization. So it may come as a shock to learn that many health care professionals and organizations do not know what to do…or even consider it their responsibility to do anything. In this provocative talk, Dr. Michael Hogan describes how the Zero Suicide approach aims to improve care and outcomes for individuals at risk of suicide in health care systems.

Michael Hogan, PhD, is an independent advisor and consultant with Hogan Health Solutions. He serves on the Executive Committee of the National Action Alliance for Suicide Prevention, a public-private partnership advancing the National Strategy for Suicide Prevention (2012). Dr. Hogan was the Public Sector Co-Lead of the Clinical Care and Intervention Task Force that developed the idea of Zero Suicide; he now co-leads the Zero Suicide Advisory Group which strives to promote suicide prevention as a core component of health care services.

www.zerosuicide.com

Episode 25: The Assessment, Management, and Treatment of Suicidal Patients

Suicide is the 10th leading cause of death in the United States and the most frequent crisis encountered by mental health professionals. This video/podcast reviews basic information about the assessment, management, and treatment of patients at risk to die from suicide. It fulfills Act 74 requirements for Pennsylvania licensed psychologists, social workers, marriage and family therapists, and professional counselors.

Program Learning Objectives:

At the end of this program the participants will learn basic information that will help them to

1. Assess patients who are at risk to die from a suicide attempt;
2. Manage the risks of suicide; and
3. Treat patients who are at risk to die from a suicide attempt.

Podcast

Video

Resources

Bongar, B., & Sullivan, G. (2013). The suicidal patient: Clinical and legal standards of care. (3rd ed.). Washington, DC: American Psychological Association.

Bryan, C. J. (2015). Cognitive behavior strategies for preventing suicidal attempts. NY: Routledge.

Jamison, K. R. (2000). Night Falls Fast: Understanding suicide. New York: Random House.

Jobes, D. (2016). Managing suicide risk (2nd Ed.). NY: Guilford.

Joiner, T. (2005). The myths of suicide. Cambridge, MA: Harvard University Press.

McKeon, R. (2009). Suicidal behavior. Cambridge, MA: Hogrefe & Huber.

Disclaimer

As an educational program, this podcast/video does not purport to provide clinical or legal advice on any particular patient. Listeners or viewers with concerns about the assessment, management, or treatment of any patient are urged to seek clinical or legal advice. Also, individual psychotherapists need to use their clinical judgment with their patients and incorporate procedures or techniques not covered in this podcast/video, or modify or omit certain recommendations herein because of the unique needs of their patients.

This one-hour video/podcast provides a basic introduction to the assessment, management, and treatment of patients at risk to die from a suicide attempt. This podcast/video may be a useful refresher course for experienced clinicians. However, listeners/viewers should not assume that the completion of this course will, in and of itself, make them qualified to assess or treat individuals who are at risk to die from suicide. For those who do not have formal training in suicide, this podcast/video should be seen as providing an introduction or exposure to the professional literature on this topic.

Proficiency in dealing with suicidal patients, like proficiency in other areas of professional practice, is best achieved through an organized sequence of study including mastery of a basic foundation of knowledge and attitudes, and supervision. It is impossible to give a fixed number of hours of continuing education and supervision that professionals need to have before they can be considered proficient in assessing, managing, and treating suicidal patients. Much depends on their existing knowledge base and overall level of clinical skill. It would be indicated to look at competency standards from noted authorities, such as those developed by the American Association of Suicidology ( http://www.sprc.org/training-events/amsr), by David Rudd and his associates (Rudd et al., 2008), or Cramer et al. (2014).

After you review the material, click here to link to CE credit.

Click here for slides related to the podcast.