Zero Suicide Healthcare Framework

This page has been developed with Zero Suicide Institute of Australasia (ZSIA) and the US Zero Suicide Institute and Education Development Centre.

The Zero Suicide Healthcare Framework is a continuous quality improvement initiative and system-wide, organisational commitment to safer suicide care in health systems. The framework is based on the realisation that suicidal individuals often fall through the cracks in a sometimes  fragmented and distracted healthcare system. A systematic approach to quality improvement in these settings is both available and necessary. 

To support health services implementing the Zero Suicide approach training programs can be found here.

What is Zero Suicide Healthcare?  

Rooted in universal human values and based on scientific evidence Zero Suicide Healthcare is a worldwide transformative approach that aims for a shift of mindset in healthcare and society: from passive acceptance to active prevention. Its inspirational goal drives healthcare systems to continually improve the quality of care. 

For those who turn to healthcare services Zero Suicide offers a better experience when feeling suicidal. Suicidality is discussed openly, treated directly and managed in a least restrictive, recovery-oriented way. As people transition through the system, no person falls through the cracks. 

Zero Suicide Healthcare is not an isolated strategy. It is a complement to other community-based suicide prevention initiatives which will be running simultaneously. 

Why is it important?  

Globally more than 800, 000 people die of suicide every year. Evidence shows that many more suicides are prevented in healthcare systems which provide better suicide prevention care. Radical system transformation can drive down suicide rates to zero. 

Who is it for? 

Healthcare leaders are the drivers of the Zero Suicide Healthcare Framework and, within their system, protectors of a safe and just culture of learning and improving. 

It is for all staff working in healthcare. Working in a Zero Suicide organisation means they are well trained and supported to provide excellent suicide prevention care; and feel safe to find and repair root causes underlying adverse events. 

Last but not least, it is for all partners, for governments and politicians; media; industries and employers; public health and suicide prevention organisations; persons with lived experience and scientists. With their force, expertise and willingness they partner together with healthcare systems to move the needle and drive down population suicide rates.   

For an overview of the Zero Suicide approach, check out the Zero Suicide Healthcare Call to Action video below:

The Zero Suicide Healthcare Framework 

The US Zero Suicide Institute has developed a comprehensive toolkit specifically designed to support the implementation of the framework. The seven elements combine to provide a comprehensive and coordinated approach to the way in which people seeking care are received, treated and supported within the health service

Essential Elements  

Lead: Instilling the belief that suicide can be prevented, with strong focus on high reliability and continuous improvement, while supporting staff and creating a ‘just culture’ which is free from blame and stigma.

Train: Develop skills for a standardised approach to risk formulation and safety planning, including counselling and reducing access to lethal means. Queensland developed the Suicide Risk Assessment and Management for Emergency Departments “train the trainer” program.

Identify: Development of a centralised, consistent and systematic approach to identifying suicide risks to ensure a consistent approach is adopted and executed across all Zero Suicide sites.

Engage: Development of processes and procedures for effective continuous engagement, with KPIs aligned to these practices. Involves every patient being closely followed through their engagement with the health system, re-engaging at every encounter no matter the reason for the visit.

Treat: Provision of effective and proven treatment. Research evidence strongly supports targeting and treating suicidal ideation and behaviours specifically and directly, independent of diagnosis, as well as any diagnosed mental health or substance abuse problem.

Transition: Appropriate transition out of the healthcare system with provision for follow-up care and support minimises the risk of suicide post-discharge. Transferring sufficient medical data at each transition point to minimise need for patient to relive their story each time.

Improve: Development of a framework for continuous improvement and lessons learnt, to ensure the model remains aligned with best practice.