Suicide Safer Care: A Public Health Approach to Training Primary Care Providers in Addressing Suicide

"Tragically, [the troubling decline in life expectancy over the last few years] is largely driven by deaths from drug overdose and suicide. Life expectancy gives us a snapshot of the nation's overall health, and these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable."

—Robert R. Redfield, MD, CDC Director¹

According to the American Foundation for Suicide Prevention and the CDC, suicide is the 10th leading cause of death in the United States.² In 2017, 47,173 people died by suicide in the U.S., and there were an estimated 1.4 million attempts.² Suicide is one of three leading causes on the list that are on the rapid rise, as suicide rates have increased by almost 30% since 1999 in more than half of states.³ Suicide has become the third leading cause of death for youth ages 10–14 and the second leading cause of death for teens and young adults ages 15–24 and 25–34.⁴

It is instructive to compare the management of chronic illnesses with that of suicide. Since 1970, death rates from stroke have decreased by 77%, heart disease by 68%, and diabetes by 17%, despite their burden and risk factors remaining high.⁵ Although the number of people who died by suicide (over 47,000) was more than half those who died by diabetes (80,058) in 2017, the eff orts to address suicide in training programs and residencies are not equivalent to such eff orts for the other leading causes of death or consistent with death rates. In addition, these numbers do not take into account the estimated 1.4 million suicide attempts each year, which cost the health system approximately $69 billion in dollars and hospital stays.² Exacerbating this issue, few health care organizations, regardless of size, have a sense of how many patients in their care are at risk for suicide, or how many have died by suicide. Additionally, many organizations do not even include suicide risk on their problem list, despite the importance of all members of the care team knowing it is a diagnosis that is a risk to survival. In comparison, most organizations have diabetes registries and can quickly report on the number of diabetics. Hospitals have a registry of heart surgery patients and track them for periods of time after surgery. Despite rising numbers and growing severity, there are currently few to no similar eff orts for suicide.

The Suicide Safer Care Project

Primary care providers (PCPs) are in a pivotal position to reduce life-threatening health conditions, including being at risk for suicide. One study found that over 80% of people who died by suicide had at least one primary care visit within 12 months prior to their death,⁶ and another found that 45% of people who had died by suicide completed a visit with their primary care physician within a month before their death.⁷ Primary care providers must have the knowledge, confidence, and training to identify and care for these patients. In response to such findings, a training program was developed to off er primary care teams the opportunity to talk about the impact of suicide in primary care settings, review evidence-based approaches for screening, assessment, and intervention, and develop skills for engaging with patients who may be at risk for suicide. This 90-minute, in-person training focuses on teaching primary care providers and the members of their team simple and eff ective ways to help their patient population by providing a comprehensive, skills-based learning opportunity with hands-on strategies that can be used with patients during a primary care visit. The training boosts providers' knowledge, confidence, and comfort around treating patients at risk for suicide, and covers how suicide safer care techniques can be incorporated into regular primary care visits. Skills developed during the training include identifying patients at risk, conducting risk assessments using a standardized and evidence-based...