There is no one-size-fits-all approach to treating and preventing suicidal behavior. That is why it’s important to understand a variety of research-based strategies that can help you most effectively serve your patients’ unique needs.
1) Train Providers
Research shows that clinicians are likely to come in contact with individuals at risk for suicide over the course of their training and careers, but too few clinicians (even those trained in behavioral health) are adequately prepared to work with individuals at risk for suicide.
It is critical to assess the training needs of clinicians in your organization. For example, a staged training approach might be best-suited to your organization’s needs where all staff has basic knowledge and skills to identify individuals at risk for suicide, and clinicians most likely to see high-risk patients receive advanced training in suicide assessment and treatment. Research can inform the most effective models for sustaining clinician knowledge include ongoing training sessions like annual training or regular online training.
The National Action Alliance for Suicide Prevention recently released Suicide Prevention and the Clinical Workforce: Guidelines for Training. This tool can help you develop suicide training guidelines specific to the needs of your organization’s clinical staff to improve the delivery of suicide care.
2) Increase access to affordable care
Suicide rates are higher where there is less access to trauma centers and where there are high rates of uninsured individuals. There are a number of ways to improve access to affordable care. Mental health parity benefits legislation is one way to encourage utilization of mental health services for people who need them. Implementation of comprehensive parity legislation has proven to increase access to care, increase diagnosis of mental health conditions and reduce the prevalence of poor mental health and suicide rates. Specifically, strong state mental health parity laws have been associated with decreases in suicide rates in the year after the law is enacted.
3) Improve Continuity of care
A 2010 research review on continuity of care concluded that the lack of continuity of care within and across systems increases suicide risk. Repeated follow-up contacts after hospitalization or emergency care have been found to reduce suicidal behavior.
Consider how your organization can establish systems, policies and practices that improve the likelihood of continuity of care for your patients at risk for suicide as part of your standard care, and how you can track these improvements.
One promising example is from Henry Ford Health System’s Perfect Depression Care initiative. In 2001, Henry Ford implemented follow-up appointments based on risk level, established access to a 24-hour crisis line, offered online and drop-in appointments provided email contact and tracked patient follow-up in an electronic medical record system. The results were impressive with suicide mortality rates dropping from over 100 per 100,000 to less than 20 per 100,000 after full implementation.
4) Increase help-seeking and referrals for at-risk individuals
Reluctance to seek help is often multi-faceted. Embarrassment or shame, the belief that treatment is not needed, treatment would not be effective, treatment is inconvenient and/or difficult to obtain, treatment will be unpleasant, or treatment would be detrimental to a specific career path are all factors that can discourage people in need from pursuing care.
To improve help-seeking, it is important for clinicians and organizations to address this reluctance, whether it is related to self-stigma or other beliefs that get in the way. It is not enough to talk broadly about improving awareness by “reducing stigma.” In fact, experts suggest avoiding the term “stigma” in public messaging as it can reinforce negative attitudes and be counter-productive. Instead, it may be more useful to provide stories of successful treatment—by expert providers, peer support specialists and/or family members—where describing a range of effective treatment options and outcomes could improve the community’s knowledge about behavioral health services.
