STEVE INSKEEP, HOST:
Today in Your Health, we explore whether it is possible to prevent every single suicide, driving the suicide rate to zero.
RENEE MONTAGNE, HOST:
That's an ambitious goal, to say the least. The suicide rate in the U.S. has actually grown slightly in the past decade.
INSKEEP: Some people are trying for zero suicides all the same. It is the goal of a health system in Detroit, which has enjoyed impressive results. Reporter Joanne Silberner begins this story with one client of that health system who is still around to tell her story.
JOANNE SILBERNER, BYLINE: Thirty years ago, Lynn developed a disease that would eventually threaten her life - manic-depressive illness. Fifteen years ago, it overwhelmed her, and she overdosed on some pills.
LYNN: I couldn't go on. I couldn't handle the pain anymore.
SILBERNER: Lynn is sharing her medical history and her fight to live on the condition that we don't share her full name to protect her privacy. Though she survived that time, she would attempt to end her life again and again and again, as often as monthly at one point.
LYNN: There are times where you overdose or attempt to hurt yourself where you really just want to die. And then there's other times where I've overdosed where it's like I just want the pain to stop.
SILBERNER: She says what pushed her to the brink time after time was something inside.
LYNN: When I was in the depths, the very depths of depression, I was being pulled and sucked into this black tunnel that was just pulling me and pulling me. And I was desperately trying to grab onto something to stop being sucked in.
SILBERNER: Others have spoken and written about the deep pain Lynn felt. Author William Styron once described his own depression as the pain of drowning. Around the time Lynn's suicide attempts started, she signed up for health insurance with the Henry Ford Health System in Detroit. And soon after she signed on, the health system began a formal program, a deliberate and concerted effort to reduce suicides among their population to zero.
NICOLE GLICKMAN: Come on in.
SILBERNER: Recently, Lynn came to a Henry Ford clinic in Detroit.
GLICKMAN: How are you?
SILBERNER: These visits are part of what this zero-plan does. It starts with primary care doctors who screen every patient for depression. Patients who come up positive are encouraged to try talk-therapy, group counseling, drugs or hospitalization if warranted. Administrative staff are trained to make sure any patient who needs follow-up gets an appointment. Therapists involve patients' families and ask that guns or other means of suicide are removed from their homes. Patients write their own safety plans. All that attention to prevention pays off.
GLICKMAN: So how have things been going?
LYNN: This week's been a real mixed week.
SILBERNER: Lynn felt a depression coming on and was upset by a conversation with a friend. She talked to therapist Nicole Glickman about thoughts she had had of taking some pills, of overdosing to escape from the pain.
GLICKMAN: What prevented you from taking them out?
LYNN: Knowing and believing that it was going to pass.
SILBERNER: Lynn has two safety plans written out - one in her cupboard and the other by her night stand. They're specific - therapist phone numbers, things to do - call for help, sit on her balcony, do some drawing or painting and remember that this feeling will pass. It has before.
GLICKMAN: Are you feeling safe now?
LYNN: I am feeling safe now. I'm not feeling as depressed as I was then.
SILBERNER: Getting health providers at Henry Ford to accept zero as the goal meant a fundamental change in belief systems about suicide, says Brian Ahmedani. He's an epidemiologist who joined Henry Ford a few years ago to measure how things are going.
BRIAN AHMEDANI: Traditionally, we had always addressed suicide as something that was inevitable, something that we couldn't really do much about. If somebody wanted to die, that they were going to do that, regardless of what we did.
SILBERNER: When Lynn came into the Henry Ford Health System, providers were being told the opposite - never to give up on suicidal patients.
LYNN: There is no question that the message I got from day one is that they knew they could help me, and they would help me.
SILBERNER: And Lynn hasn't made any suicide attempts in the last five years.
LYNN: I guess I'm one of their big success stories, then. I'm one of those zeros.
SILBERNER: She's clear about what would've happened without Henry Ford.
LYNN: I wouldn't be here. I wouldn't be here.
SILBERNER: Brian Ahmedani says the numbers in the high-risk mental health population support the program.
AHMEDANI: For 2009, it was possible. We had a rate of 0 per 100,000, and everyone always told us that that was not possible.
SILBERNER: Especially in the middle of some trying economic times for people in Detroit. Now, the zero suicide rate only held for two years. It's up now to 20 per 100,000 per year in the high-risk population, but that's still 80 percent lower than before the program started. And for the general population, it's 5 per 100,000 - way below the rate for the rest of Michigan. And regarding cost, the folks at Henry Ford say they haven't yet done a comprehensive analysis, but a similar program modeled on Henry Ford actually reported some cost savings. Zero suicide seems to be catching on around the country. Clinicians here, like Jeff Devore, say zero is worth striving for.
JEFF DEVORE: Is it possible to completely prevent suicide - have zero suicides? Well, anything's possible, right? I mean, isn't it? That's the goal.
SILBERNER: And Lynn? Lynn credits perseverance by staff of the Henry Ford Health System and her own.
LYNN: I have persevered in learning to speak up for myself and that I should and that I deserve it. And I hope others can hear that. The mentally ill person, their family - there is always hope, and I am living proof of it.
SILBERNER: Several years ago, Lynn got a tattoo on her left arm - hope, it says. And the next year on her right arm - joy. Recently, she told me something she would not have said 10 or 15 years ago - I will never attempt suicide again. For NPR News, I'm Joanne Silberner.
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