Background & Goals
After learning about multiple nurse suicides within her organization, Judy Davidson, DNP, RN, MCCM, FAAN, and her team discovered there was no recent research within the United States on the incidence of nurse suicide. The last time it had been studied was in the 1990s. Dr. Davidson and her team led a pilot study in San Diego, utilizing 10 years of medical examiner data, which found that nurses were at a higher risk of committing suicide than the general public.
This is especially pertinent in 2021 – two years into the COVID-19 pandemic. Nurses are seeing an unprecedented increase in the number of patients in dire condition and healthcare systems are being tested in ways they haven’t before. The incredible emotional toll of working through this period has amplified the need for nurse suicide intervention and a focus on mental health for nurses and healthcare providers.
The goals of the Nurse Suicide Prevention model are to shift nursing culture from solely focusing on caring for others to caring for ourselves as well, decreasing stigma surrounding nurses seeking mental health treatment through educational outreach, providing ‘in the moment care’ through group emotional debriefing after critical incidents, and proactively, anonymously identifying and referring nurses in need of treatment or at risk of suicide. These debriefings are interdisciplinary and all who have cared for a patient or were affected by an event are welcome. This support is integral to a team-based approach to healing and strengthens the caring community.
Program Description
The Suicide Prevention in Nursing: Breaking the Silence model is an evidence-based suicide prevention program for nurses, backed upon investigator-initiated research, to quantify incidence and characteristics of nurse suicide in the United States. By increasing education and outreach to dispel the stigma around mental health, the program advocates for better resources to support the mental health of nurses, which ultimately saves lives.
The Suicide Prevention in Nursing model was developed by an interprofessional team inspired by the novel research and the first national longitudinal study of U.S nurse suicide led by Judy E. Davidson, DNP, RN, MCCM, FAAN, Nurse Scientist at the University of California, San Diego Health Sciences (UC San Diego Health). Dr. Davidson collaborated with her colleagues at UC San Diego Health; William Norcross, MD, Sidney Zisook, MD, Brittany Kirby, MSW, Gianna DeMichele, LMFT, Rachael Accardi, LCSW, Courtney Sanchez, LCSW, and Julie Kawasaki, LCSW. The team was aware that a suicide prevention program, the Healer Education Assessment and Referral (HEAR), was launched at UC San Diego School of Medicine in 2009 for physicians and medical students but no program existed specifically for nurses. This spurred the initiative to include nurses and other non-physician healthcare workers.
The Nurse Suicide Prevention model utilizes an Interactive Screening Program (ISP). The ISP offers nurses a safe and confidential way to conduct a brief screening and connect with mental health services to receive support and access to treatment options – anonymously. The ISP is a licensed program of the American Foundation of Suicide Prevention.
The main elements of the program are:
- A proactive screening program which can detect nurses with risk factors such as substance use disorder, depression, anxiety disorders, and suicidality;
- 1:1 bridge therapy that is anonymous and/or confidential without showing on participants’ medical records;
- Referral to mental health treatment, when indicated, which can be done while remaining anonymous;
- Group emotional process debriefings after significant workplace events, facilitated by specialized therapists; and
- Educational outreach.
Evidence of Success
In 2016, during the first year of the program’s launch, 40 nurses received counseling and 17 were successfully referred for continued treatment. Over a five-year period, between 2016 and 2020, Suicide Prevention in Nursing, has identified and transferred close to 300 nurses into treatment. In addition, over 1,000 nurses have benefited from group emotional process debriefings after critical events during its operation.
Since its launch, at least six organizations have replicated the program, using the American Foundation of Suicide Prevention ISP to screen nurses for suicide prevention. It is a cost-effective strategy to overcome the stigma of seeking help for mental health issues.
The National Suicide Prevention Lifeline is 1-800-273-8255. Other international suicide helplines can be found at befrienders.org.