The Centers for Disease Control and Prevention recently reported the surprising news that the national mortality rate climbed in 2015 for the first time in a decade. The unexpected uptick was linked to increases for several causes of death, including suicide.
While the rising suicide rate and its role in increasing national mortality are troubling, there is cause for hope. The preventable nature of suicide—the 10th leading cause of death in the U.S.—raises the question of what can be done to better detect and treat individuals with suicidal thoughts before they reach the point of no return.
All too often, it turns out, physicians and mental health professionals have simply not been adequately tuned in to preventing suicide. In multiple studies over the years, up to 45% of all patients and a shocking 78% of older people who die by suicide saw a medical doctor in the month before they died. But something was missing. Most of the time, those patients were not asked about self-harm or suicide. When it comes to most of healthcare, a “don't ask, don't tell” approach to suicidal thoughts has been all too common.
According to a 2006 study conducted in South Carolina, 10% of all suicide deaths were among people recently seen in emergency departments. They may have been asked about self-harm if suicidal impulses brought them to the hospital. But effective interventions to prevent suicide may not have been fully employed.
In addition, many mental health professionals, including therapists, psychologists and psychiatrists, simply aren't properly trained to treat suicidal patients as part of their graduate education or licensing requirements. A few states, such as Kentucky and Washington, have recognized this gap and passed laws to require continuing education in suicide care.
It does not have to be this way. A new article in Health Affairs, authored by myself and Julie Goldstein Grumet, Ph.D., explores the effective screening tools and treatments that already exist. The tools for effective suicide prevention have been bundled in an approach we call Zero Suicide in Health Care, and implemented successfully in clinics and health systems. These interventions begin with screening all patients with risk factors such as mental health problems, and following a care pathway for those with high suicide risk. The care pathway includes developing a one-page personalized safety plan, engaging patients and families in self-care, and having hospital staff follow up by phone in the days and weeks following the visit.
The mortality rate from suicide for individuals with severe and persistent mental illness is about 12 to 20 times higher than in the general population. In 2001, Henry Ford Health System in Detroit adopted a comprehensive approach to suicide care that they called the Perfect Depression Care initiative—a systematic quality-improvement program that reduced suicide deaths among people receiving care by over 75% and which was closer to the suicide rate in the general population. The Henry Ford approach was implemented within the mental health service line, and sought defect-free care on each of the dimensions of the quality chasm framework (all care should be safe, effective, efficient, timely, patient-centered and equitable). More than 200 healthcare organizations in the U.S., with others in the Netherlands and United Kingdom, have already put it in place.
But this is only a beginning. Most healthcare today cannot be labeled as “suicide safe,” and taking on the mission of suicide prevention is a continuing challenge for healthcare organizations. The Joint Commission, the leading accreditor of hospitals, this past February issued a Sentinel Event Alert putting provider organizations on notice that more needs to be done to detect suicidal thoughts and feelings among patients. We hope that these developments, and new leadership from healthcare professionals to prevent suicide, can make a difference. Suicides are preventable—if we work at it.
Michael Hogan, Ph.D., is a clinical professor in the psychiatry department at Case Western Reserve University School of Medicine in Cleveland.
