On average, approximately 130 Americans die by suicide each day. Since the outbreak of COVID-19, there has been concern that stressors induced by the pandemic, such as social isolation, economic challenges, depression and limited access to healthcare services, would increase suicidal behaviors. While the Centers for Disease Control and Prevention found that overall suicide rates decreased during COVID-19, rates increased among young people and people of color, the latter of which were disproportionately affected by the pandemic.
All of that said, suicide remains a concern among all racial, ethnic and socioeconomic groups, and as a result, payers have an opportunity to change the approach to suicide prevention through provider and community partnerships.
Nearly 50% of individuals who die by suicide saw a primary-care provider in the prior 30 days, and more than 80% saw a behavioral health specialist or primary-care provider a year before their death. Yet in a survey conducted by the Association of Clinicians for the Underserved (ACU), "one in five providers had never received training on how to recognize warning signs that patients may be at elevated risk for suicide, and 32% lacked confidence in their ability to provide treatment to patients with suicidal thoughts or behaviors."
Because suicide is associated with several risk factors and variables contributing to a person's level of distress, payers and providers must collaborate to address physical, mental, socio-economic and other influencers. Seventy percent of behavioral health concerns are treated in a primary-care office, so it is vital that these providers have the tools to identify, treat and refer members to specialty care as needed. Given this, Centene partnered with ACU to develop and deliver a suicide prevention curriculum to more than 1,700 primary-care providers and staff in 16 states on suicide risk assessment and intervention.
Payers have access to substantial amounts of data and can conduct analytics to identify those at highest risk of suicide, allowing providers to intervene earlier and provide appropriate care or referrals. By combining data with innovative technology, payers and providers can partner to identify those at-risk to help prevent suicide attempts and behaviors. Through the use of machine learning, we can create and implement models that accurately identify an individual's risk levels, empowering providers to effectively intervene. We have combined data science, clinical expertise of psychiatrists and psychologists, and business intelligence to create an analytical model that identifies members with the highest risk of suicide. Our clinically trained case managers can then proactively coordinate needed services for those at risk, which not only saves lives, but also decreases inpatient admissions, avoidable emergency department visits, and total medical and behavioral health costs.
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Beyond prevention and identification, providers can also aid those who have attempted suicide through interventions such as clinical treatments and outreach. Research shows that by providing follow-up care and other support, suicides across the country could be decreased by 20%. From education and digital/teletherapy to higher levels of care management, clinical teams can tailor care to the individual to ensure compassionate support. Payers and providers can also leverage tools and resources like communication from the care management team during care transitions and support for families of those who commit suicide.
Social workers in particular are often on the front lines and therefore play a critical role in suicide prevention, yet many have reported feeling unprepared and uncomfortable to do so. Evidence-informed training can help social workers identify signs of distress and engage members in needed care. Care programs must also be culturally sensitive and look to identify, then address, social determinants of health. Social workers have a deep understanding of these unique challenges. Social isolation, financial stress, unemployment and other SDOH can be suicide risk factors. In addition, adverse childhood experiences such as violence, neglect and substance use can increase suicide risk. Addressing these complex issues will improve the effectiveness of outreach and intervention.
Payers and providers can play a critical role in reducing unnecessary loss of life and the impact on family, friends and community members. Through improved access to high-quality individualized suicide-prevention care, partnering with social service agencies and organizations, and using advanced technology to better identify those at risk, together we can improve the quality of life for those in greatest distress.