A magazine for friends of the Warren Alpert Medical School of Brown University.

Getting to Zero


With patients’ advice and new tools, a hospital aims to prevent all suicide deaths.

Try to imagine yourself in the shoes of someone who wants to take their own life. “Think about the pain and the hopelessness and the devastation that they felt, that it actually got to the point that they wanted to die,” says Robin Furcolo, 55, of Westerly, RI, who lost her sister, uncle, and cousin to suicide, and has attempted suicide herself. “People don’t see that side at all.”

Listening to those with experiences like Furcolo’s is central to the new Zero Suicide Initiative at Butler Hospital, which aims to reduce suicides in its inpatient programs and after patients are discharged. “It’s important to us that on our committees, we have the patient voice and the family voice represented,” says Diane Block, PhD, Butler’s director of quality and patient experience.

As part of the new initiative, Block and Michael Armey, PhD F’12, an associate professor of psychiatry and human behavior (research), have been speaking with doctors at the hospital about how to talk about suicide. They’ve held trainings for clinicians on safety planning, and discussed how to improve the tracking of local suicide deaths. In the face of climbing national suicide rates—up 22 percent from 2006 to 2016, according to the CDC—Block expects major changes for the hospital in the next year.

Furcolo, a member of Butler’s Pat-ient and Family Advisory Committee, emphasizes the importance of doctors listening carefully to patients. “You can’t come in dictating,” she says. “You have to build a rapport, work together as a team. Listen to what they have to say and how they feel.”

Butler’s Zero Suicide Initiative follows recommendations from the national Zero Suicide effort, which contends that suicide deaths are preventable. The team will examine how suicide is documented at Butler and what services have proved to be most beneficial for those vulnerable to suicide, among other topics. A first step for the initiative will be looking inward—understanding how patients with high suicide risk experience care at Butler.

To identify such patients, Armey is studying patterns of behavior that are tied to suicide risk, to better understand how that risk originates, he says. His department also is exploring interventions involving landline phones and mobile devices. “We really want to try to leverage what we know on the science side of things to improve both our assessments as well as our interventions,” he says.

The initiative’s aims extend beyond Butler’s doors. Transitions of care are known to be dangerous times for patients at risk of suicide: Furcolo says hospitals often discharge patients without plans for their continued care, leaving them even more vulnerable. After a suicide attempt, people often form plans to end their lives in case the urge returns.

“That line is very, very easy to cross the second time,” Furcolo says. “When you feel alone and you feel like you have no one to turn to, and nobody cares and you feel like you’re hopeless and you are desperate, you think about ending the pain. And you will think about suicide.”

The Zero Suicide Initiative is part of the Patient Safety Movement, which seeks to lessen harm to patients resulting from preventable medical errors, Block says. “This is that same philosophy turned to psychiatry,” she adds.

Furcolo encourages providers to ask patients with depression if they’re considering hurting themselves or taking their own lives. “Most of the time you’re going to get an honest answer,” she says. “I think most people do want help.”

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255.


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