My colleague Ursula Whiteside and I have an ongoing discussion (or maybe even debate) about “Zero Suicide”, the name of the comprehensive program developed by the National Action Alliance for Suicide Prevention. “Zero Suicide” is a bold, aspirational name - similar to the Juvenile Diabetes Research Foundation’s campaign titled “Cure 4 Type 1”. I enthusiastically support that bold aspiration, and I heartily agree that even a single death by suicide is one too many. My reservation is not about the aspiration, but about the accountability.

Group Health Cooperative, where I practice, has actually embraced accountability for assessing and addressing suicide risk. At every mental health visit, patients 13 and older are expected to complete a brief questionnaire including the PHQ9 depression scale. Whenever responses to that questionnaire indicate frequent thoughts of death or self-harm, the treating therapist or psychiatrist is expected to complete a standard assessment of suicide risk. Whenever that assessment indicates moderate or high risk, the clinician is expected to help the patient develop and record a specific safety plan. Most important, every step in that process is recorded in the electronic health record. Completion of those steps is tracked for each clinician, each clinic, and the system as a whole. Beginning in 2016, Group Health’s psychiatrists will be held personally accountable for conducting and recording suicide risk assessments for any patient scoring high on item 9 of the PHQ9. Performance on that measure will be part of each psychiatrist’s performance-based compensation, with possible gains and losses in pay.

My test report for the fourth quarter of 2015 (shown above) brought home to me the difference between aspiration and accountability. When one of my patients scored high on item 9, I recorded a suicide risk assessment only 81.6% of the time. If this were a real report (rather than a test), my poor performance in this area would have reduced my pay by $334 for the quarter. Whether I like it or not, that’s accountability.

The lesson for me is that improving the quality and safety of mental health care (for suicide prevention or anything else) takes more than just caring about the problem and knowing what should be done. When it comes to suicide prevention, I really do care. And I think that I know what should be done. Ironically, I helped design the care processes and performance measures in which I performed so poorly! Caring and knowing are both important, but it’s what we actually do that makes care safer or more effective.

I tell Ursula that I’d prefer a different name for the National Action Alliance campaign. I’d call it “Zero Defects in Healthcare for Suicide”. That title doesn’t roll off the tongue as easily. But it’s an aspiration for which I can - and should - hold myself accountable.