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Primary Care and Emergency Providers Can Help Prevent Suicide

An important finding about suicide is spurring a new approach to reducing it: In the month before they take their own lives, many people who die by suicide seek medical or psychological care.

These patients don’t come to their local clinic or hospital for help with suicidal thoughts, but with other medical or mental health issues. They may have traumatic brain injury, or they could be depressed. They may have chronic health problems. They might have gone to the emergency department following a drug overdose. Those conditions are treated, but the patient is not necessarily assessed for suicidal risk.

By evaluating all patients at risk of suicide no matter their reason for seeking care, immediately treating those at risk, and providing follow-up care, health care systems can substantially reduce suicides, presenters said at the 2015 summit of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

“The potential is there for primary and behavioral health providers to reduce suicide,” said Eileen F. Zeller, an official with the Substance Abuse and Mental Health Services Administration (SAMHSA).

Reason for Doctor Visits

There’s a simple reason that so many people who turn to suicide have recently sought care: many of the conditions that are major risk factors for suicide also require physical or psychological treatment, explained Zeller, lead public health advisor at the SAMHSA Suicide Prevention Branch. Among the major risk factors are prior suicide attempts, mental disorders such as depression, substance use disorders, head trauma, stressful life events, and chronic medical conditions, she said. Patients seeking treatment for these problems often wind up in an emergency department, local clinic or low-cost community therapy.

Among service members, 45 percent of those who died by suicide and 73 percent of those who attempted suicide were outpatients within 30 days of the event, mostly at non-military facilities, according to a 2012 study.

That’s a problem since many community and emergency room providers lack the capacity to evaluate and manage potentially suicidal patients—even mental health professionals, Zeller said. More than half, 53 percent, of 30,000 mental health professionals in a nine-state survey said that they lacked the skills, training or support to recognize and cope with a patient at high suicide risk.

Four Gaps in Care

The mindset of health care institutions will need to change in order to treat suicide effectively, said Adam Chu, a prevention specialist with the federally-funded Suicide Prevention Resource Center in Waltham, Massachusetts.

“A systematic clinical approach in health systems is needed so that prevention does not rely on the efforts of crisis staff or individual clinicians but is the responsibility of the entire system,” Chu said. The approach is embodied in Zero Suicide, a facet of the National Strategy for Suicide Prevention. Zero Suicide focuses on reducing error and improving safety in health care systems, creates a framework for systematic clinical suicide prevention, and offers a set of best practices and tools.

Providers can use the Zero Suicide tools and practices to fill in four areas where gaps may exist:

  • Screening, assessment and risk formulation
  • Collaborative safety planning
  • Treating suicidal thoughts and behaviors
  • Continuity of care

Health care systems with reduced suicide rates have adopted a model for screening and assessing risk in patients when they present in any health care setting, including primary care, and ensuring that they receive appropriate treatment and follow-up. Examples of such systems are the Air Force Suicide Prevention Program and “Perfect Depression Care,” which measured the success of care by the reduced suicide rate, by the Henry Ford Health System in Detroit, Michigan.

A webinar offering more information about system-wide suicide prevention is available on the Center’s Zero Suicide page.

Preventing suicide in emergency departments

Lisa Capoccia, assistant manager of provider initiatives for the Suicide Prevention Resource Center, explained how emergency room and primary care providers could care for adult patients who pose a suicide risk.

A free resource for providers, “Caring for Adult Patients with Suicide Risk,” includes a decision support tool for clinicians, a list of brief interventions for suicide prevention, and a discharge planning checklist, Capoccia said.

Among the recommendations: make sure a patient at risk for suicide has been scheduled for a follow-up visit with either a mental health provider or a primary care doctor before leaving the clinic and that the patient has a safety plan.

VA resources

The Department of Veterans Affairs also offers tools and training in preventing suicide to community health organizations, said Janet Kemp, associate director and education chief of the VISN2 Center of Excellence for Suicide Prevention in Canandigua, New York. Kemp invited those seeking training or education assistance for their facility to contact her directly.

Full presentations of the speakers at the 2015 Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury Summit can be found on the event website.

If you or someone you know may be considering suicide, seek immediate help — call a local crisis center, dial 911, or take the individual to an emergency room. Free, confidential help is available 24/7 through the Military Crisis Line (also known as the Veterans Crisis Line and National Suicide Prevention Lifeline) at 800-273-8255 (service members and veterans press 1). You can also chat online or send a text to 838255. Even if there’s no immediate crisis, trained counselors can offer guidance on how to help someone and direct you to information and local resources.

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