Geries Shaheen • February 16, 2023

Zero Suicide: A Model to Live By

Suicide is a leading cause of death in the United States: According to the Centers for Disease Control and Prevention (CDC), suicide is the 10th leading cause of death in the United States, with a rate of 14.0 suicides per 100,000 people in 2020.


Suicide rates have been increasing in recent years: The CDC reports that suicide rates in the United States have been increasing since 1999, with the highest rate recorded in 2020.


Access to mental health services is a key factor in preventing suicide: Studies have shown that access to mental health services can play a critical role in preventing suicide. However, only about half of individuals in the United States with a mental illness receive treatment, which can lead to a higher risk of suicide. Improving access to mental health services, especially for those at high risk of suicide, is a key factor in reducing the rate of suicide.


This past year, I have had the opportunity to receive extensive training in the Zero Suicide Model, as well as join a Zero Suicide Collaborative! Yes, these exist!


The Zero Suicide Model is a comprehensive approach to suicide prevention in healthcare organizations. It is based on the idea that suicide deaths for individuals under the care of health systems are preventable, and it aims to reduce the number of suicide deaths through a combination of clinical, organizational, and cultural changes. The Zero Suicide Institute is a non-profit organization that provides training, resources, and technical assistance to healthcare organizations to implement the Zero Suicide Model.


This Model is an evidence-based approach that has been shown to reduce suicide deaths in health systems. It consists of seven key components: leadership commitment, clinical best practices, a suicide care management team, data-driven quality improvement, suicide risk assessment, and safety planning, employee training and cultural competence, and ongoing evaluation and improvement.

Leadership commitment is essential to the success of the Zero Suicide Model. The organization's leadership must make a public commitment to the prevention of suicide deaths and create an infrastructure to support the implementation of the model. This includes ensuring that the resources and support are in place for the staff to implement the model effectively.

Clinical best practices are an important component of the Zero Suicide Model. This includes evidence-based assessments, risk stratification, and evidence-based treatments for those at risk of suicide. It is essential for healthcare organizations to provide their staff with the training and resources they need to effectively assess and treat individuals at risk of suicide.

The Zero Suicide Model also includes a suicide care management team, which is responsible for ensuring that all patients at risk of suicide receive appropriate care. This team should include individuals from various departments, such as psychiatry, nursing, social work, and primary care. The team should also have the resources and support they need to effectively coordinate care for patients at risk of suicide.

Data-driven quality improvement is a crucial component of the Zero Suicide Model. This involves regularly collecting and analyzing data to monitor the effectiveness of the model and identify areas for improvement. The data should be used to inform clinical decision-making and guide the development of new best practices for suicide prevention.


Suicide risk assessment and safety planning are critical components of the Zero Suicide Model. All patients at risk of suicide should receive a comprehensive assessment to determine their level of risk and develop a safety plan to reduce that risk. This safety plan should include information on warning signs, coping strategies, and the steps to take in the event of a crisis.

Employee training and cultural competence are also important components of the Zero Suicide Model. All staff, including those who may not work directly with patients, should receive training on suicide prevention and risk assessment. This training should help staff understand the warning signs of suicide, how to respond to a crisis, and how to provide appropriate referrals for those at risk of suicide.

Finally, ongoing evaluation and improvement are essential to the success of the Zero Suicide Model. Regular evaluations should be conducted to monitor the effectiveness of the model and identify areas for improvement. This feedback should be used to make ongoing improvements to the model, to ensure that it remains effective in reducing the number of suicide deaths.


Consider these action steps in confronting suicide prevention in your agency or practice:


1) Integrative in-depth charting that showcases the golden thread regarding suicide prevention. A data-driven system that showcases comparative charts. How many clients indicated having suicidal hx, or suicidal ideation? Of these, how many received a safety plan? Of those, how many clients indicated utilizing said safety plan? Collectively, how many were assessed within sessions at each session for suicidality? This data-driven approach will help bring to light any gaps that may exist systematically.


2) Consider surveying your agency annually and upon hire. How many of your workforce know how to respond if another staff, a stakeholder, or a client presents signs of suicidality? For a long time, suicidality has been seen as a personal concept not to be discussed. This Model suggests the opposite. Suicide is a community disruptor, and thus it is everyone’s responsibility. You may be surprised at your findings. Connecting training completion numbers will also give you a sense of security knowing your agency is on the same page regarding suicide prevention.


3) Incident Reporting monitoring for charting EMS and Hospitalizations. Indicating how many are related directly to suicidality.


4) Collaboration with staff/ teams in developing effective/evidence-based responses to suicidality. These are to be constructed as action steps within the incident reports themselves. Mitigation both from a formal lens, and a 1x1 approach.


5) Incorporating accessibility to mental health services (even if they are not through you or your agency) after hours 24/7. Accessible care does not always mean it must be territorial care- you can not be all things to all people all of the time. Consider a variety of tools/ hotlines/ apps/ community centers/ private practices as means to equip the client.


In the most recent Zero Suicide Collaborative meeting, we discussed IFS- internal family systems, as well as the development/ implementation of Peer-Led Suicide Prevention groups. Derek Vaughn from the Gibson center in Cape Girardeau Missouri reflected on their groups called the 988 group.

We viewed resources like the following: 


https://drexel.edu/familyintervention/abft-training-program/abft-training/Self%20Paced%20Course/

https://didihirsch.org/download-best-practices-manuals-toolkits/

We even had a rep from the Missouri Department of Mental Health (DMH)/ Casey Muckler, showcase a new magazine type resources rolling out to schools! See below



https://www.flipsnack.com/pathtomysuccessprograms/988_guide-for-schools/full-view.html


In conclusion, the Zero Suicide Model is a comprehensive approach to suicide prevention that has been shown to be effective in reducing the number of suicide deaths in health systems. The Zero Suicide Institute provides training, resources, and technical assistance to healthcare organizations to implement the model effectively. By implementing the Zero Suicide Model, healthcare organizations can play a critical role in preventing suicide deaths and improving the lives of individuals at risk of suicide.


Geries Shaheen is a Licensed Professional Counselor and Nationally Certified Counselor operating in and around St. Louis Missouri. Geries holds his MA in Professional Counseling from Lindenwood University, BA in Intercultural Studies from Lincoln Christian University, and holds a certificate in Life Coaching, Geries provides life coaching services to clients online globally. Geries is EMDR trained and DBT Certified, practicing from a TIC lens.The body content of your post goes here. To edit this text, click on it and delete this default text and start typing your own or paste your own from a different source.

Pioneer Counseling Blog

Navigating Change in 2026 with Resilience and Hope

By Geries Shaheen • January 3, 2026
January invites reflection. In 2026, whether you’re a clinician supporting others or a client investing in your own healing, one truth remains constant: change is inevitable—but growth is intentional. The way we engage with change shapes outcomes more than the change itself. While mental health frameworks, technologies, and conversations continue to evolve, the core of healing remains deeply human—rooted in connection, meaning, and courage. The Bigger Picture: A Need That’s Real, and Hopeful Mental health challenges are widespread, yet the story does not end there. Globally, over 1 billion people live with a mental health condition. In the United States, nearly 1 in 4 adults experienced a mental health concern in the past year. At the same time, recent data shows improvements in youth mental health, including reductions in major depressive episodes and suicidal ideation. These numbers tell a dual story: the need is significant, and progress is possible. For Clinicians: Where Science Meets Presence We practice at the intersection of evidence and empathy. Recent trends show that more than half of adults with mental health conditions are now receiving treatment, and nearly 70% of individuals with serious mental illness are accessing care. Additionally, close to nine out of ten people who engage in therapy report meaningful improvements in their lives. What this reinforces in 2026: Evidence-based modalities matter, but how they are delivered matters just as much. Emotional safety is not optional; it is foundational. Small, often quiet gains are still powerful indicators of change. Progress does not always look dramatic. Sometimes it looks like a client naming an emotion more clearly, setting a boundary, or returning after a difficult week. These moments count. For Clients: Your Healing Is Not a Performance If you are in therapy, or considering it, these truths are worth holding onto this year: You are not behind. Healing has no universal timeline. Your voice matters. Therapy works best when your values and lived experience shape the process. Progress is rarely linear. Growth often includes pauses, detours, and revisiting old ground with new insight. Therapy is not about becoming a different person. It is about becoming more fully yourself. The data supports this: the vast majority of people who engage in counseling report improvements in confidence, emotional regulation, and overall well-being. A Shared Journey Forward Clinicians and clients are not on opposite sides of the work, we are collaborators in a shared human process. Hope in 2026 is not blind optimism. It is grounded in effort, connection, and skill-building. It shows up in sessions that feel hard but honest, in moments of insight that arrive quietly, and in the courage to keep showing up. As this year unfolds, may healing feel attainable, growth feel sustainable, and change feel less overwhelming. One intentional step at a time. Geries Shaheen is a Licensed Professional Counselor and Nationally Certified Counselor operating in and around St. Louis Missouri. Geries holds his MA in Professional Counseling from Lindenwood University, BA in Intercultural Studies from Lincoln Christian University, and holds a certificate in Life Coaching, Geries provides life coaching services to clients online globally. Geries is EMDR trained and DBT Certified, practicing from a TIC lens.

DBT Nightmare Protocol

By Geries Shaheen • March 25, 2023
Dialectical Behavior Therapy (DBT) was developed by psychologist Marsha Linehan in the 1980s to treat individuals with borderline personality disorder (BPD). DBT combines cognitive-behavioral therapy (CBT) with mindfulness and emphasizes acceptance and validation of intense emotions. It involves weekly individual and group therapy sessions, where individuals learn specific skills related to mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. DBT has since been adapted to treat a range of mental health conditions and is recognized as an evidence-based treatment. DBT has been proven effective in treating a wide range of mental health conditions, including borderline personality disorder, substance abuse, and eating disorders. One of the key components of DBT is the use of specific protocols to address common issues that clients may experience. One of these protocols is the DBT Nightmare Protocol, which is designed to help individuals who are experiencing recurring nightmares. Nightmares are a common experience for many people, and they can be particularly distressing for individuals who have experienced trauma. In fact, nightmares are a symptom of post-traumatic stress disorder (PTSD), and they can be a significant barrier to healing for individuals who are struggling with this condition. The DBT Nightmare Protocol was developed to help these individuals manage their nightmares and reduce their overall distress. The DBT Nightmare Protocol is a 10-week protocol that is designed to help individuals learn to manage their nightmares through a combination of behavioral strategies and cognitive techniques. The protocol is typically conducted in a group setting, although it can also be done on an individual basis. The following is an overview of the different components of the DBT Nightmare Protocol. Week 1: Psychoeducation The first week of the DBT Nightmare Protocol is dedicated to psychoeducation. During this week, the therapist will provide information about nightmares and the impact they can have on mental health. Clients will also learn about the common triggers for nightmares and the different ways in which nightmares can be managed. Week 2: Sleep Hygiene During the second week of the DBT Nightmare Protocol, clients will learn about sleep hygiene. This includes information about the importance of getting enough sleep, as well as strategies for improving sleep quality. Clients will also learn about the relationship between sleep and nightmares, and they will be provided with specific strategies for reducing the frequency and intensity of their nightmares. Week 3: Imagery Rehearsal Therapy Imagery rehearsal therapy (IRT) is a technique that is commonly used to treat nightmares. During the third week of the DBT Nightmare Protocol, clients will learn about IRT and how it can be used to reduce the frequency and intensity of nightmares. Clients will also have the opportunity to practice IRT techniques with the guidance of their therapist. In IRT, your therapist first provides you with background information on sleep and nightmares to "set the scene" for learning to manage them. Then, working with your therapist, you create detailed, nonfrightening endings for nightmares you've had repeatedly. Write down and rehearse the nightmares with the new endings. Learn how to monitor your nightmares so you know how well your IRT treatment is working. The goal is to "reprogram" your nightmares to be less terrifying if and when they occur again. Week 4: Mindfulness Mindfulness is a key component of DBT, and it can be particularly helpful for individuals who are experiencing nightmares. During the fourth week of the DBT Nightmare Protocol, clients will learn about mindfulness and how it can be used to manage anxiety and other symptoms associated with nightmares. Week 5: Progressive Muscle Relaxation Progressive muscle relaxation (PMR) is a relaxation technique that involves tensing and then relaxing different muscle groups in the body. This technique can be particularly helpful for individuals who are experiencing nightmares. During the fifth week of the DBT Nightmare Protocol, clients will learn about PMR and how it can be used to reduce the intensity of nightmares. Week 6: Cognitive Restructuring Cognitive restructuring is a technique that is used to challenge negative thought patterns and beliefs. During the sixth week of the DBT Nightmare Protocol, clients will learn about cognitive restructuring and how it can be used to challenge negative beliefs and thoughts that contribute to nightmares. People sometimes experience distorted thinking. Thought patterns that create an unhealthy perspective of reality. Cognitive distortions often lead to depression, anxiety, relationship problems, and self-defeating behaviors. Examples of cognitive distortions include: black-and-white thinking catastrophizing overgeneralizing personalizing Cognitive restructuring allows you to notice these maladaptive thoughts as they’re occurring. And then practice reframing these thoughts in more accurate ways. During this step, you will question your assumptions, gather evidence by self-monitoring on a daily basis, and perform cost-benefit various analyses. If you can change how you look at certain events or circumstances, your feelings and the actions you take may also change. Week 7: Graded Exposure Graded exposure is a technique that involves gradually exposing oneself to a feared situation or object. During the seventh week of the DBT Nightmare Protocol, clients will learn about graded exposure and how it can be used to reduce the fear associated with nightmares. Week 8: Relaxation Training Relaxation training is a technique that involves teaching individuals to relax their bodies and minds. During the eighth week of the DBT Nightmare Protocol, clients will learn about relaxation training and how it can be used to reduce anxiety and other symptoms associated with nightmares. Clients will also have the opportunity to practice relaxation techniques with the guidance of their therapist. Week 9: Self-Compassion Self-compassion is an important component of DBT, and it can be particularly helpful for individuals who have experienced trauma. During the ninth week of the DBT Nightmare Protocol, clients will learn about self-compassion and how it can be used to reduce self-criticism and self-blame associated with nightmares. Week 10: Relapse Prevention The final week of the DBT Nightmare Protocol is focused on relapse prevention. During this week, clients will learn about the different strategies they can use to maintain the progress they have made in managing their nightmares. They will also be encouraged to develop a plan for how they will continue to manage their nightmares after the end of the protocol. The DBT Nightmare Protocol is a comprehensive and effective approach to managing nightmares. By incorporating a range of behavioral and cognitive strategies, clients are able to learn the skills they need to reduce the frequency and intensity of their nightmares. If you are experiencing nightmares, it may be helpful to speak with a mental health professional who is trained in DBT to see if the DBT Nightmare Protocol is right for you. Unsure about adapting DBT into your framework? -A randomized controlled trial of DBT for suicidal and self-injuring individuals with BPD found that DBT was more effective than treatment as usual in reducing suicidal and self-injurious behaviors (Linehan et al., 2006). -A meta-analysis of 11 randomized controlled trials of DBT for individuals with BPD found that DBT was effective in reducing suicidal and self-injurious behaviors, as well as other symptoms of BPD, such as depression and anxiety (Kliem et al., 2010). -A randomized controlled trial of DBT for individuals with binge eating disorder found that DBT was more effective than treatment as usual in reducing binge eating and improving eating disorder-related attitudes and behaviors (Safer et al., 2010). -A review of 17 studies of DBT for individuals with substance use disorders found that DBT was effective in reducing substance use and improving overall functioning (Linehan et al., 2002). Overall, research suggests that DBT is an effective treatment for a range of mental health conditions, including BPD, eating disorders, substance use disorders, and post-traumatic stress disorder (PTSD). It is worth noting that the effectiveness of DBT can vary depending on individual factors, such as the severity of symptoms and the level of treatment adherence. Perhaps you are a private practice in the mental health industry, or maybe a large agency trying to get your clinicians on the same page regarding Trauma Informed Care. Consider the Pioneer Counseling Trauma Informed Care Psychotherapy Tx Planner. It really is more than a tx planner, it is a guide and a point of reference. https://www.amazon.com/dp/B0BQ9FWFMT?ref_=cm_sw_r_cp_ud_dp_0MKBDBQ5PRD8G8NBEJ0B No alt text provided for this image Geries Shaheen is a Licensed Professional Counselor and Nationally Certified Counselor operating in and around St. Louis Missouri. Geries holds his MA in Professional Counseling from Lindenwood University, BA in Intercultural Studies from Lincoln Christian University, and holds a certificate in Life Coaching, Geries provides life coaching services to clients online globally. Geries is EMDR trained and DBT Certified, practicing from a Trauma Informed Care lens.e body content of your post goes here. To edit this text, click on it and delete this default text and start typing your own or paste your own from a different source.
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