OUTAGAMIE COUNTY DEPARTMENT OF

HEALTH AND HUMAN SERVICESMENTAL HEALTH DIVISION

NIATx Team

Diane Mandler

and

Lisa Anderson

DATA AND AIMBASELINE DATA• 2013: 7 Clients died by suicide• Outpatient wait list: 6 weeks for a

psychiatrist and 4 weeks for a therapist.ORIGINAL AIM• Reduce client suicide rate from 7 to 0. SECONDARY AIM• Shorten outpatient waitlist from weeks

to days.

CHANGE FOR PRIMARY AND SECONDARY AIMSPERFECT DEPRESSION MODEL• Next day follow up• Weapons/means restriction• Family Involvement• Adverse Event Analysis• Zero suicide philosophyPRIORITY ACCESS MODEL (P.A.M)• For clients with a moderate or severe level of need,

screened by Crisis Phone Staff.• Priority Access appointments available Monday-Friday.• Outpatient and Crisis Therapist share responsibility for

schedule• Schedule appointment with psychiatrist and therapist

at time of PAM appointment.

RESULTS• PERFECT DEPRESSION MODEL SURVEY– Pretest, Post-test and Re-test

• Do you think suicide can be prevented?– Strongly Agree 18% 57% 40%– Agree 56% 32% 56%– Neutral 15% 11% 4%– Disagree 8% 0 0– Strongly Disagree 3% 0 0

• Do you believe that some people will attempt suicide no matter what– Strongly Agree 26% 0 4%– Agree 51% 3% 20%– Neutral 8% 34% 20%– Disagree 15% 37% 36% – Strongly Disagree 0 26% 20%

• Seeking collateral information on people who are suicidal is important– Strongly Agree 54% 64% 84%– Agree 25% 28% 16%– Neutral 3% 0 0– Disagree 13% 4% 0– Strongly Disagree 5% 4% 0

• Most individuals who are suicidal are ambivalent about attempting suicide– Strongly Agree 54% 64% 84%– Agree 25% 28% 16%– Neutral 3% 0 0– Disagree 13% 4% 0– Strongly Disagree 5% 4% 0

RESULTSPRIORITY ACCESS MODEL Decreased wait list time Reduced hospitalizations Increased client and staff satisfaction Decreased no show rate from 50% to

11% Increased revenue

LESSONS LEARNEDPERFECT DEPRESSION MODEL• Remind staff to ask about means

restriction, especially firearms.• Continue to educate staff regarding the

philosophy of zero depressionPRIORITY ACCESS MODEL• Easier to start than believed by

administration and staff.• Some staff struggle with change and

expect resistance• Move forward no matter what

NEXT STEPSPERFECT DEPRESSION MODEL• Begin to collaborate with community to

decrease suicide rate• Nurture stronger belief in zero suicide as

a goal.PRIORITY ACCESS MODEL• Start walk-in clinic for increased access

to services• Survey clients to determine level of

satisfaction