Immediate Intervention Prevents Almost 100 Percent of Repeat Suicide Attempts: Experts

A special intervention program almost completely eliminated the number of suicides among those who attempted it at least once.

The program was initiated in 2017 at Rambam Health Care Campus, in the northern district of Israel. The unique approach is meant to prevent repeated suicide attempts among those who end up in a hospital emergency room (ER).

mental health

In the last five years, results show an almost 100 percent success rate. Since the program was implemented, out of 600 people who tried to commit suicide and wound up in the ER, 599 were prevented from ending their lives.

In the same year that Rambam launched its program, 402 suicide cases were recorded in Israel, according to Ministry of Health (MoH) data: 305 were men and 97 women. Suicide is the second leading cause of death for boys aged 15–24, the third for girls at the same age and also for men aged 25–44.

As for recorded suicide attempts in Israel between the years 2009–2019, there were 6,200 cases per year on average, with the number going up to 6,838 in 2019. The rate of suicide attempts during 2012–2019 remained stable with the rate for women 1.3–1.4 times higher compared with men.

According to U.S. CDC data, suicide is a leading cause of death in the United States, with 45,979 recorded deaths in 2020—about one death every 11 minutes.

The numbers are even higher for people who think about or attempt suicide. Records show that in 2020, about 12.2 million American adults seriously considered suicide, 3.2 million planned an attempt, and 1.2 million attempted suicide. In the same year, suicide was the second leading cause of death for people ages 10–14 and 25–34.

Pilot Program

pilot project was developed at the end of 2008 when Avraham Levi, a psychiatric social worker and director of the social work department in the psychiatry division at Rambam, received a request from the MoH to establish a pilot program for the prevention of repeated suicide attempts.

The request came after data from a similar program launched in 2006 for preventing suicide attempts in the Israel Defense Forces (IDF) reduced suicide cases by 63 percent, Dr. Eyal Fruchter, a psychiatrist and then the head of the mental health department in the IDF Medical Corps, told The Epoch Times.

It started in two hospitals at the time; one of them was Rambam.

The main problem was that people who ended up in an ER after trying to commit suicide were not receiving an intervention treatment for suicide until many months later.

“That is the most significant, most dangerous contraindication for people in crisis,” Levi told The Epoch Times.

The goal was to build a program that would be well-tailored from a systemic and psychotherapeutic point of view to provide an immediate crisis intervention “to help people who are in life-and-death situations,” he said.

The pilot program lasted until 2012. The emergency response staff who received suicide patients would inform the therapists who were trained in crisis intervention.

According to Fruchter, an outside company was hired for this pilot to provide 30 treatment sessions to any of the patients who consented to receive help.

This pilot that included only a few dozen patients was successful and reduced the rate of repeated suicide attempts, he said. But it ended because of a lack of funds.

Clinical Program

In 2016, Fruchter became the director of the psychiatric division at Rambam. He is also a clinical assistant professor at the Technion—Israel Institute of Technology.

Fruchter and Levi decided to create a program offering intervention and treatment for patients at high risk within the resources that they had available.

They implemented the new program in September 2017, stitching it together in a tight way to make sure that every case that arrived in the ER and signed a consent form—whether the patient was a concrete suicidal attempt or had concrete suicidal thoughts—was contacted and invited to treatment sessions in the mental health clinic.

The program was created based on two insights, according to Fruchter.

One is that “we know that suicide can be prevented,” he said. It had already been proven that it can be prevented, “if the right steps are taken.”

The other insight is that a suicide attempt is the No. 1 risk factor for a repeat suicide attempt. He said most people who try to commit suicide will make a “repeated attempt during the 3 to 6 months after a previous attempt.”

Based on these two insights, they created a program that addressed anyone who arrives at the hospital after a suicide attempt and who does not have any other therapy framework in the community outside of the hospital.

“We have a very regular and strict procedure,” said Levi.

Those that have a care provider outside of the hospital and do not need hospitalization will be referred back to the community with a letter that notes for them to quickly get to their therapist, said Fruchter.

However, the majority of these patients do not have a place of treatment to be referred to, and as of today, the likelihood is very low for them to see a psychiatrist or a therapist—who understands the profession and knows how to intervene in a crisis, within a period of 3–6 months after being released from the hospital. The waiting time for appointments is very long, and they are hard to access, said Fruchter. These are people who often tend to give up, fall through the cracks, and not attend treatment sessions.

That is why, he said, the staff prioritized this affected population that is at high risk and provided them with a therapeutic solution.

An Immediate Contact

The first step of the program is for the care providers to reach the patients who end up in the hospital ER as soon as possible.

The gold standard would be for the staff to contact the patients in the ER, understand their circumstances, and offer them an appointment as soon as possible, within 48–72 hours. If they agree, they will be asked to sign a consent form and will be invited to two to three treatment sessions at the mental health clinic.

In the treatment sessions, the staff performs an assessment to determine what kind of intervention is needed, tailoring evidenced-based therapy models to the needs and conditions of each patient.

Fruchter said they have a number of therapists who asked to participate in the project and underwent specific crisis intervention training offered by himself and Levi.

Many of the therapists are social workers, said Fruchter, yet they can be from all professions, including include doctors, psychiatrists, psychologists, interns and experts, nursing staff, and occupational therapists. Once every year or two they refresh the team members with additional training and add more members to the trained staff.

When a person is ready to use suicide as a way out, “if no response is taken in the first 3 months, 50 percent of them will make another suicide attempt,” said Levi.

Immediate intervention can reduce—in the long term of a year to two years—the risk for a repeated suicide attempt by 50 percent, “meaning, with such an acute intervention, all-in-all quite simple, it is dramatic for saving lives.”

Crisis Intervention During the Hospitalization

The second step for the patients is two to three meetings with trained crisis intervention staff.

Of those who agree to attend the sessions, 50–52 percent actually attend the crisis intervention meetings, said Levi. This does not mean that those who did not attend the sessions are left with no intervention.

“The very fact that there is a follow-up, the very fact that there is a check-up—‘what is happening to you? how are you?’” and checking in with them has a dramatic effect on lowering the suicidal risk in the immediate term, said Levi.

There is a lot of literature that shows that the very act of immediate intervention, even if the patient did not attend the treatment sessions during a crisis, lowers the risk by about 30 percent, he said. Just the fact that staff spoke with the patient reduces the suicidal risk.

According to studies done around the world, even just a phone call from the hospital was found to reduce the number of repeated suicide attempts, said Fruchter. “We also saw this in our data.”

An Impulsive Act

The significant factor is that the suicidal act is often impulsive, and not planned. Where there is a very immediate urge to do it, if there will be all kinds of physical, human, and other barriers on their way, they will not do it.

“That is why it is so important to make an immediate connection and express interest because loneliness is the main fuel that can lead to an impulsive act,” Levi said.

“One of the classic situations of people who have made suicidal attempts is that they are in [a state of] ambivalence,” he said. “They are on the swing of I want to die now and at the same time I want to live.”

“It could be anyone,” said Fruchter, but what characterizes them is that they are in crisis which brought them to the idea that it is better for them to die, and “that they have no way out.”

So what they need is crisis intervention that expands the picture, analyzing things, adding a significant other or a friend, or a family member into the conversation.

During the two-to-three treatment sessions the staff assess the current trigger that led to the suicidal attempt, and the current status of the patient: whether these thoughts are still active. They identify personal, family, and social resources to determine how to leverage coping, and tailor the ongoing program once they are released back to the community, said Levi.

Community Interfaces

The third step is to make sure that these people do not fall into the gap after their release from the hospital.

When the patients are done with the intervention sessions, Levi is responsible to make sure that they will be provided with appropriate interfaces in the community as quickly as possible. He informs the district doctor who will direct the patients for further rapid psychiatric and psychosocial treatment according to their individual needs.

There is a tight interface from the moment of the acute crisis to the second when the process ends and the patient goes back into the community, said Levi.

The hospital also made sure to save the patients the paperwork to avoid long wait times when they approach the health management organizations [HMOs]—organizations in Israel that provide health care—which fund their ongoing treatment. “We formed a tight axis between us,” said Levi.

Levi and Fruchter contacted the four HMOs in Israel and they all agreed to allow these patients automatic access to treatments in Rambam once the mental-health clinic contacts them regarding these individuals.

“We didn’t invent anything, we simply took what was in the literature and stitched it together in an integrative way,” he said.

“We worked out a very regulated and clear intervention structure, with very clear principles,” said Fruchter. A model of a very intensive intervention with a very fast response “to show the patient that there are other solutions.”

“The numbers speak for themselves,” said Fruchter. “It’s even much more positive than what I had hoped for.”

In the United States, contact the 988 Suicide and Crisis Lifeline if you are experiencing mental health-related distress or are worried about a loved one who may need crisis support.

Reposted from:

This article is part of the mental health series of articles.



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