University of Washington
Need help now?  Call the National Suicide Prevention Lifeline at 1.800.273.8255
Need Help Now? Call the National Suicide Prevention Lifeline. 1.800.273.8255

Primary care plays key role in suicide prevention

Primary care plays key role in suicide prevention

Washington can be a model for suicide prevention and integrated health care, says Dr. John Osborn of the Spokane Veterans Administration Medical Center.  Photo by Marc Schillios

Nearly half of all individuals who die by suicide visit their primary care physicians less than a month before taking their own lives. That reality has doctors, nurses and the larger suicide prevention community talking about the importance of primary care in saving lives.

The primary care conversation has intensified since the 2012 passage of the Matt Adler Suicide Assessment, Management & Treatment Act, which requires suicide risk assessment and treatment training for mental health professionals. Responses to a statewide survey funded by the act make it clear that suicide prevention is important to all health care professionals, says co-investigator Elaine Walsh, a Forefront faculty affiliate in the UW School of Nursing.

Elaine Walsh, Ph.D., R.N.Primary care physicians who see patients over time can build trust and be attuned to clues, says internist John Osborn, looking back on the clinic portion of his 27 years at Spokane Veteran’s Administration Medical Center. He still remembers the instances when he caught the clue, or a patient opened up, and he was able to intervene. He also knows the pain of losing patients to suicide and wondering what, if any, clues he missed.  “When that happens, it’s awful.”

Veterans, often with PTSD or other behavioral health issues, die by suicide twice as often as the general public. When Osborn became Spokane VA’s Chief of Medicine in 2010, he arranged suicide prevention training for the clinical staff, but he knows much more needs to be done.

When screening questions flag a problem, doctors—both in the VA and the broader community where most vets receive medical care—are juggling so many medical concerns and related issues, that depression or suicide ideation may be overlooked.

From his current VA vantage point as a hospitalist caring for patients primarily on hospital wards and in the emergency room, Osborn says, “You’d think I’d be required to have training, but I’m not. There’s nothing similar to CPR to help staff understand the risk, or when to refer and where.”

Nurses also work in front-line positions for suicide prevention. They often are the first person a patient sees, and also the ones who coordinate the transition to home or another service, points out Walsh. “Nurses show up on surveys as the most trusted profession.  They have entré into people’s lives, which makes them perfectly poised for suicide prevention,” she says.

Osborn and Walsh are part of a statewide stakeholders group exploring ways to improve primary care providers’ capacity to identify and refer patients at risk for suicide. Forefront, in collaboration with State Rep. Tina Orwall (Des Moines), is convening the multi-disciplinary group of more than 50 professionals to share concerns and pursue solutions. Orwall also has introduced a bill to expand the training requirements to all licensed health care professionals and create a pilot program to support primary care providers with psychiatric consultation for diagnoses and treatment.  HB2015 has 15 co-sponsors and is scheduled for a public hearing before the Health & Wellness Committee on Jan. 22. A number of stakeholders will testify at the hearing, which will which will be broadcast live by TVW and archived on its website.

“We know that early intervention in the treatment of depression and other risk factors for suicide can prevent deaths,” says Forefront Faculty Director Jennifer Stuber, who is co-leading the stakeholders group. Washington is moving toward integrating behavioral health and primary care, and she’s hopeful that this group will build momentum for change.

Promising steps include evidence-based collaborative care models for integrating primary care and behavioral health, which have been shown to be clinically successful and cost effective for a variety of mental health conditions. Several health systems in the state are moving in that direction. Washington State also funds the Partnership Access Line (PAL) a mental health consultation line connecting primary care providers with behavioral health expertise and referral information for children’s mental health issues.

The stakeholders’ work is bigger than Washington State, stresses Osborn. “It’s important that people understand that this is cutting-edge work and cutting-edge reform.  The impact will go far beyond the state. It will become a model in the long journey to suicide prevention and integrated health care.” — by Sue Lockett John