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The Zero Suicide framework in healthcare is a system-wide approach to care after a suicide attempt with the goal that no suicides should occur when a person is in contact with the health service.1 It is predicated on seven elements: lead, train, identify, engage, treat, transition and improve. These elements of clinical care rely on systematic protocols that should involve ongoing risk screening and assessment, collaborative safety planning, access to evidence-based suicide-specific care, focus on lethal means reduction, consistent engagement efforts and support during high-risk periods.2 The Zero Suicide framework has seen a rapid adoption, having been implemented in over 200 healthcare and behavioural health organisations worldwide by 2016.3 The Zero Suicide framework was substantially influenced by the Perfect Depression Care initiative,4 of the Henry Ford Health System in Michigan, USA, which was shown to reduce the rate of deaths by suicide by 75% in the first 4 years of implementation.5–7 More recently, Centerstone in Tennessee reported a 65% reduction in the rate of deaths by suicide among patients treated for a variety of psychiatric conditions after implementing the Zero Suicide framework.3 However, initial evaluations have drawn criticism, owing to their observational nature, concerns about overstated outcomes and caution being expressed in comparing the Zero Suicide framework with the Perfect Depression Care model.6,8 Despite the widespread rollout of Zero Suicide framework, there remains a lack of robust evidence for its effectiveness published internationally1,6 and we are not aware of any such research from Australia.
Implementation of the Zero Suicide framework at Gold Coast Mental Health and Specialist Services, Queensland, Australia
Although the Zero Suicide framework provides an overarching framework, it does not prescribe in detail the clinical components to be implemented. At Gold Coast Mental Health and Specialist Services (GCMHSS), a clinical suicide prevention pathway (SPP) based on Zero Suicide framework was rolled out in December 2016. Table 1 illustrates the tools and interventions comprising the SPP; they are listed in the order of their use following an individual's presentation to the hospital.
Table 1 Suicide prevention pathway (SPP) elements based on the Zero Suicide framework implemented at the Gold Coast Mental Health and Specialist Services
| Suicide prevention pathway element | Assessment tool/Treatment | Additional details |
| Screening and engagement |