Rethinking suicide prevention with Dr. Craig Bryan

We are excited to welcome Craig Bryan, PsyD, ABPP as our next Mind Matters speaker!

Dr. Bryan, renowned suicidologist and trauma psychologist, will challenge current wisdom on suicide prevention and propose alternative perspectives to guide suicide prevention efforts at our final Mind Matters meeting of the year tonight at 5:30 pm.

By the conclusion of the meeting, participants will understand the relationship between mental health conditions and suicide, the multiple pathways model of suicide, and be able to identify the five levels of the prevention through design model.

If you have a case you'd like to share for consultation and support at this or a future Mind Matters meeting, please email Anitha Iyer, PhD, Course Director.

Remember that you can view recordings and slides of previous meetings on our website. Past meetings have covered treating depression and anxiety in primary care, substance use, eating and feeding disorders, and more.

Most recently, Dr. Eyal Shemesh spoke about the challenges and limitations in routine depression screening.

You may be anxious to ask directly about suicidal ideation. By starting the conversation, providing support, and directing help to those who need it, we can prevent suicides and save lives. Asking about suicide does not encourage suicidal thoughts.

Remember, patients are often ambivalent, do not necessarily want to end their lives, but may see no other way out of their pain.

Treat the interview as an exploration and engender confidence that there are alternatives. Be calm and reflect empathy and concern. Get collateral information from the medical record and friends/family when possible. 

Next steps: For more advice on engaging patients in conversations about suicidal ideation, review our Provider's Guide to Suicide Risk Assessment.

An unpredictable phenomenon: who dies by suicide?

Up to 79% of people who die by suicide will die on their first attempt. This stark reality makes immediately clear the importance of effective early detection and intervention. At the same time, approximately half of all people who die by suicide denied any suicidal ideation or behaviors at their last care encounter, and are identified as “low risk.” Despite the numerous advancements in health care over the last forty years, our ability to accurately predict suicide has not improved.

An original investigation published in JAMA Psychiatry earlier this year analyzed 306,800 suicide decedents from 2003-2020 for insights into risk factors, circumstances of death, toxicology, and method. They found five distinct profiles: (1) comorbid mental health problems and substance use, (2) mental health problems without substance use, (3) crisis, alcohol-related, and intimate-partner problems, (4) physical health problems, and (5) polysubstance use. From these five classes, the authors argue for tailored prevention strategies.

Class 4, decedents with physical health problems, was not only the largest cohort, but also the fastest growing, increasing over 30% since 2016. Significantly, this group had a strikingly low rate of diagnosed mental disorders and toxicology-detected psychotropic medication use (Just over 2% of individuals in this group had antidepressants present upon autopsy, compared with over 50% in class 1). They consulted non-mental health care professionals twice as often as mental health professionals in the 30 days prior to death. They were most likely to use firearms—a highly lethal choice of means: self-inflicted gunshot wounds are fatal in over 90% of cases versus drug overdoses, which are fatal only about 8% of the time.

This group highlights all too clearly the role primary care providers and non-mental health care providers can and must play in suicide prevention. MSHP has made a concerted effort to promote annual depression screening for all patients; this data highlights the significance of coordinated care for physical and mental health care, especially for patients living with chronic illnesses who may be at increased risk for suicidality. 

See also: A Holistic Approach to Suicide Prevention: Screening Limitations and Implications for Primary Care Providers by Amy Bennett-Staub on the MSHP Behavioral Health Blog

Suicidality is a leading cause of death in the United States. Knowing which patients to have a deeper conversation with can save lives.

Watch these short (under 1 minute) videos to know the risk factors and warning signs.

• Risk Factors for Suicide
• Suicide Warning Signs
• Talking with Patients about Suicide
• Safety Planning for Suicide Prevention

Learn more: Find more suicide prevention resources, video interviews, and more on the Behavioral Health Hub.

Ensure your patients are aware that their insurance provider must cover behavioral health benefits with no session caps. This quick guide explains how to find treatment and services and includes information about understanding insurance coverage and benefits.

Epic users can include this information as part of the After Visit Summary by using dot phrase .behavioralhealthresourceguide.

It's no secret that there is high stigma surrounding mental health which can be incredibly harmful to people living with mental health conditions and interfere with their treatment and recovery.

The CDC offers a variety of provider resources on mental health literacy, including a CME course from the University of Texas at Austin on stigma-free communication about mental health.

Spanish language resources from the National Institute of Mental Health (NIMH)

NIMH has patient-friendly information about a variety of mental health topics in Spanish. Share this information with Spanish-speaking patients to help them understand any relevant topics or diagnoses.

Information to share with your patients: living with chronic illness