Pursuing an Ambitious New Zero Target in the UK

IMG_2554Clean, clear blue sky. I snapped this picture of the iconic London skyscraper known as the Shard last week, a rare one as it lacks the ubiquitous jam of black taxis, big red buses and cars crawling through the streets. But, it evokes what might be.

What would the UK capital look like if it ran on 100% clean energy? Recently, it became clear that London will in fact miss its first target for incremental improvement. The think-tank IPPR challenged mayoral candidates that it was time to get serious:

“We call on the next mayor of London to pick up the pace – and provide a plan for how they could pursue an ambitious new target, for London to be a zero-carbon city by 2050.

Hard to imagine and totally impractical given the infrastructure that exists today? Maybe, but instead of conceding smaller targets IPPR went the other way. They urged Londoners to imagine the ultimate goal and pursue it with earnest. If you guessed that the candidates balked, you would be wrong (see Mayor Candidates Commit to Zero).

We humans aspire to the heights. We tackle wicked problems. And, when we stretch and dream of the vision we desire, despite it seeming impossibly out of reach, we galvanize resources, we break through with new ideas, and we achieve amazing things.

Aspiring for Zero Suicide in London

The venue for the picture above was the Hotel Novotel. I was there to participate in a forum of the three major UK Zero Suicide pilots hosted by Public Health England. The inspiring day was led and facilitated by Director Wellbeing and Mental Health Gregor Henderson and Public Mental Health and Wellbeing Manager Helen Garnham.

It was my privilege to kick off the morning with a reflection on the current state of Zero Suicide (see my presentation PowerPoint). I started with the concept of the BHAG, a Big Hairy Audacious Goal, and reviewed the history of El Capitans that healthcare has already ascended or begun to climb (see “Is Your BHAG as Humbling as El Capitan?”).

2016-02-15_14-37-53Gregor referred to Zero Suicide as a “movement,” and it is officially an international one with growing pilots in the US, the UK and the Netherlands. The early adopters are strong missionaries carrying the flame to others. The clinical soul is deep and rich- the movement has its heart.

The evidence burned bright in three moving presentations of the UK pilots:

  • South West Strategic Clinical Network– Dr. Adrian James, Chair, challenged the group that changing the clinical approach to suicide will have cascading benefits for the overall care. The South West vision is based upon a mindset, a methodology and markers.
  • Mersey Care NHS Trust– Dr. David Fearnley, Medical Director, on the partnership with Mersey and Cheshire Suicide Reduction Network Strategic Partnership Board, “Suicides are not inevitable.” Safe and effective care and treatment exists already, but a competent and skilled workforce must be equipped.
  • East of England Strategic Clinical Network– Dr. Caroline Dollery, Clinical Director, shared key characteristics including relevant training, local community champions and creating attitudinal change.

Three different programmes, but the Henry Ford Health System focus on robust performance improvement was clearly in the DNA of each. None of them claimed any magic formula or pioneering innovation. Instead, they each believe there are tried and tested methodologies that healthcare must employ with rigour.

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Rapid Cycle Quality Improvement at Mersey Care NHS Trust

And, we are seeing the first strong steps towards strengthening the science. Andy Bell presented on the Centre for Mental Health evaluation of the East of England Zero Suicide programme. In the US, the National Institute for Mental Health has recently released RFA-MH-16-800 seeking Applied Research toward Zero Suicide Healthcare Systems.

Ann John closed out the day encouraging the group to move forward with further evaluation. As part of Public Health Wales, Ann is national lead for suicide prevention and chairs the national advisory group to Welsh Government on suicide and self harm prevention.

Alys Cole King (Connecting People) presented on training clinical professionals and Joy Hibbins (Suicide Crisis Centre) talked about her lived experience and the respite program that her team has since created to meet the needs of those at risk.

West Yorkshire Vanguard Zero Suicide

A day earlier I was in Bradford, UK, three hours north of London by train, where more than 150 clinicians, law enforcement, community stakeholders, persons with lived experience and others gathered for a summit at the Bradford City Football Stadium, “Building Resilience and Wellbeing: Zero Suicide.”

2016-02-15_9-56-55Simon Large is chief executive of the Bradford District Care NHS Foundation Trust, which operates the centre in the grounds of Airedale Hospital. He shared, “We are fully committed to the ‘zero approach’ and have been inspired by hearing the experience of others who have adopted this aspiration.” Dr. Mike Doyle is leading the local efforts, and working to develop a consistent model across West Yorkshire (see local news coverage).

Whereas in London I spoke about the outcomes and evaluation components of Zero Suicide, in Bradford my message was the clinical underpinning. Including people with lived experience (think about this experience as “lived expertise”) in the design and leadership of these programmes alongside other stakeholders creates something different. And, rejecting the myths about the inevitability of suicide for some people are key ingredients of Zero Suicide (see my presentation PowerPoint).

International expert Professor Nav Kapur provided a keynote address on the UK wide perspective from the National Confidential Inquiry. His presentation buttressed the systems approach with the 2012 findings regarding mental health services that had implemented 24 hour crisis teams, dual diagnosis policies and/or multi-disciplinary reviews. Overall, their study concluded that systemic changes save 200 to 300 lives per year (see Implementation of mental health service recommendations in England and Wales and suicide rates, 1997-2006).

An Inconvenient Truth

In December 2015, the United Nations convened in Paris a climate change conference attended by most of the countries in the world. The discussion centered on incremental improvement, and whether setting a goal of limiting global warming to less than 2 degrees Celsius (°C) compared to pre-industrial levels was enough.

By contrast, Londoners are dreaming of a city that is a global leader in climate change. Zero Carbon, they are calling it.

And, beginning in March, 2016, a group from 13 nations will release “Zero Suicide: An International Declaration for Better Healthcare” (see advance Final Draft). Zero Suicide is equal parts aspiration, social movement and culture change. It represents a new mindset to harness enthusiasm and create action.

The London event quoted Australian businessman and former politician John Brogden, “It’s the national emergency we can no longer ignore.”

So, the status report on Zero Suicide after a quick trip to the UK: We have climbers in three countries who have surveyed the wall, identified the summit, and… begun to climb. As more healthcare leaders join, let’s all make progress together.


 

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“History has shown that action by organizations can, eventually, make a large and life-saving difference, even for issues that at first together seem intractable. Stroke, AIDS and heart disease have dropped dramatically. However: not for suicide. Yet.”

Zero Suicide: An International Declaration for Better Healthcare (Final Draft)

If you are interested in supporting the global dissemination beginning March 6, 2016, please contact us to become a Zero Suicide Ambassador. 

 

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