Addressing the High Rates of Suicide Among Healthcare Workers Through an Innovative, Comprehensive, Culturally-Responsive, and Employee-Focused Program Across a Large Healthcare System

Body of Abstract: Suicide rates in healthcare associated fields have consistently been recognized to be higher than the general population. Healthcare has unique barriers to care and cultural stigma that hinder help seeking behavior (Gold & Schwenk, 2020). Those who care for others often are the least willing to seek care for themselves. OhioHealth is a non-for-profit health system with 35,000 employees, including 3800 physicians and advanced practice providers at 15 hospitals and over 200 ambulatory care sites. Over the past decade, we have been on a corporate journey to decrease stigma, change culture, and place real resources with financial backing to improve the well-being of those who serve. This has most recently culminated in the creation of a multi-year plan to create a sustained, focused, coordinated, strategic, and culturally responsive education, advocacy and outreach suicide prevention program for all healthcare employees. The suicide prevention program is integrated into the well-being work and is aimed at lowering suicide risk and encouraging help-seeking. The suicide prevention program utilizes the REACH© gatekeeper system that has been specifically adapted for healthcare to train all employees to recognize suicide risk in each other and to help all associates know how to access resources for suicide prevention.
The presenters will discuss the current state of well-being and suicide prevention in healthcare, including issues surrounding stigma, licensing, credentialing, myths, and culture. We will discuss the work that it took to create, plan, and implement a suicide prevention gatekeeper training model, leveraging in-house and external educational expertise. Inclusion is a core value of our health system. In the past, models to address well-being and suicide prevention in healthcare were often focused on patients, or were focused only on easiest to reach groups (e.g., young trainees). These efforts often ignored those who are at highest risk for health disparities. We will discuss how leveraging the internal culture of diversity, equity, and inclusion and our business resource groups has allowed us to ensure no group is forgotten or left behind.
The suicide prevention initiative begun at OhioHealth includes all associates, no matter their role. That is because we recognize that all members of healthcare professions are at elevated risk for suicide. Thus, although there has been much written lately about the elevated risk for suicide among doctors (DeCamp et al., 2021), nurses (Davis et al., 2021), residents (Ji et al., 2020), and medical students (Levy et al., 2019), there is also evidence of elevated risk among others in healthcare. EMTs, for example, have suicide rates that are more than twice the national average (Vigil et al., 2021). One large scale study of non-physician healthcare staff found that administrative staff, research staff, medical assistants, nurse practitioners, and physician assistants all had rates of suicide ideation that was more than twice the national average (Chan et al., 2024). In other words, hospital workers in every role are at elevated risk for suicide, making a comprehensive approach to suicide prevention that includes all members of the organization an important strategy.
We also recognize that there are unique stressors and challenges that medical professionals face that differ from the general population (Gold & Schwenk, 2020). That means that standardized gatekeeper trainings that are commercially available are inappropriate and potentially ineffective. It is for this reason that we created a model that is grounded in best practices and addresses the specific and unique needs of healthcare professionals and provides training and practice that meets their needs.
Over the last year, the REACH© suicide prevention program has been implemented at OhioHealth as part of the larger well-being initiative. During the first 10 months (Dec 2023-Sept 2024), there were 48 trainings across 12 care sites, and 523 OhioHealth associates in all care roles were trained. REACH trainings are 90 minutes, in person and all in small groups (average of 11 participants/training). More than 98% (514) completed a post training survey to help us better understand the impact of the work. The results overwhelmingly demonstrate significant improvement in knowledge and understanding about suicide. More importantly, after the training, more than 98% of participants agree/strongly agree that they feel 1) competent, 2) confident, and 3) willing to ask a colleague about suicide. Open-ended questions demonstrate that participants feel empowered, connected, and supported to make a difference. In addition, healthcare workers who routinely ask about suicide with their patients now feel encouraged to ask about suicide with their co-workers, and they recognize what a shift this is in their perspective. Importantly, there is evidence that the REACH training has resulted directly in 5 lives saved over the past year.

In September of 2024, the first train the trainer course was offered, and new trainers have been certified. This follows an existing model that has been demonstrated at multiple sites, where more than 40,000 individuals have been trained in REACH.

This last year of OhioHealth’s journey through gatekeeper training has revealed many unique aspects of the needs of those that work within the healthcare industry, including their unknown and unmet needs. Although there has been discussion in the literature about the high degree of distress within healthcare, this has become even more evident within these trainings. In fact, although thousands of REACH trainings have been conducted across multiple sites for more than a decade, this level of distress has never been seen before. This led to changes in the protocol to ensure absolute attendee safety. Taken together, we believe that this first in the nation specialized Gatekeeper training available to all employees of a health system, regardless of job title, is critical in the healthcare industry and paramount in changing the statistics around suicide in healthcare workers. Our comprehensive approach operationalizes the recommendations put forth by the Institute for Healthcare Improvement & CDC to address suicide within healthcare (2022).
We are proud to say we have saved 5 lives in the last year. We hope that our experience can start to change the conversation and culture not just within OhioHealth, but within all of healthcare.

Learning Objectives:

• Discuss the high degree of distress among healthcare professionals
• Explain the ground work necessary to establish prior to implementation of a suicide prevention gatekeeper training model in healthcare
• Formulate plans for protecting the safety of attendees at suicide prevention gatekeeper trainings programs in healthcare settings
• Analyze the work that is yet to be done in this space