Suicide Prevention in Integrated Care: Opportunities to Provide Advocacy, Education

Psychiatrists and other behavioral health care providers have an enormous potential to help prevent suicides by working in collaboration with primary care providers. This month’s author, Anna Ratzliff, M.D., Ph.D., provides some concrete actions we can take to help people who are struggling with thoughts of suicide.—Jürgen Unützer, M.D., M.P.H.

Psychiatrists working in integrated care settings have an important role to play in suicide prevention. Nearly 50 percent of people who die by suicide will have seen their primary care physician in the month before they die, and 83 percent will have seen a medical professional in the past year. If you are a psychiatrist working in a primary care setting, I encourage you to take action to address this public health crisis in one of the following ways: provide education to primary care teams, support protocol development, and/or expand access to the Collaborative Care Model.

• Provide education to primary care teams: By leveraging your relationship with a primary care team, you can provide education in the core skills of recognizing and managing patients at risk for suicide in primary care and other medical settings. Core training goals include making sure all medical professionals know the suicide prevention hotline number—(800) 273-TALK—and are able to ask directly about suicide, use standardized tools such as the Columbia Suicide Severity Rating Scale, and implement decision aids such as the SAFE-T to manage patients at risk. Knowing how to deliver effective educational messages, such as how to safely store medications (the most commonly used method for suicide attempts) and firearms (the most commonly used lethal means for suicide), to different kinds of audiences can make communities safer by increasing public awareness.

• Support protocol development: You may work closely on protocol development for a variety of clinical conditions, and suicide prevention should be a primary target of this work. One of the best places to start when working in a new clinic is to ask about the suicide prevention and crisis protocols that are already in place. Some clinics will have well-developed protocols, and your role may be as simple as supporting effective application of these protocols. Other practices may not have any standardized approach, and you may be able to provide leadership to develop one. There are national resources to assist with this work including free materials available from Zero Suicide and specific materials for primary care from the Suicide Prevention Resource Center.

• Implement collaborative care: A common risk factor for suicide is depression, and working to increase access to effective treatment needs to be part of suicide prevention. Implementing collaborative care is an important strategy to address this need. In the IMPACT study, the largest trial of collaborative care to date, patients were twice as likely to have a reduction in depression symptoms and a demonstrated reduction in suicidal ideation. APA offers a variety of training opportunities and resources to support implementation of collaborative care.

Last year, I helped develop and launch a suicide prevention training program (All Patients Safe) for the University of Washington and Seattle Children’s Hospital in response to Washington state legislation that requires suicide prevention training for all health care professionals. Over 1,000 people have completed the training so far, and we are beginning to see its positive impact. For example, a recent trainee reported that after completing the training, he had the tools and skills to complete a safety plan with two patients the next day in his clinic.

Seeing this success has inspired me to seek additional opportunities as a psychiatrist to provide advocacy and education in suicide prevention. I hope you can find inspiration in these ideas, bring them to your integrated care work, and help address the public health crisis of suicide. ■