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Originally published Sunday, January 26, 2014 at 4:45 PM

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Guest: The front line of suicide prevention is primary care

Doctors and nurses receive inadequate training to diagnose and treat patients at risk of suicide, writes guest columnist Jennifer Stuber.


Special to The Times

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RIGHT now, most doctors are not prepared to deal with patients who may be at risk of suicide, even though they are treating patients for depression on a regular basis.

Almost 1,000 Washington residents die by suicide each year, representing a rate 14 percent higher than the national average of 12.1 deaths per 100,000 people. Middle-aged men, Native Americans and Alaska Natives, and veterans of the U.S. armed forces are three of the highest at-risk groups. Suicide is the second leading cause of death among Washington’s young people ages 10 to 24.

Suicide is preventable for the vast majority of people who take their lives. An estimated 95 percent experienced undiagnosed, undertreated or untreated mental-health disorders including depression. Almost half saw a primary-care provider in the month before their deaths.

However, research shows that many health-care professionals — including mental-health professionals — receive inadequate training in understanding suicide and the role they can play in preventing it. A new study commissioned by the Legislature found that many Washington health-care professionals do not feel adequately prepared, and believe training in suicide prevention should be a requirement for licensure.

In the 2012 session, the Legislature passed a law requiring ongoing training in suicide prevention for mental-health professionals as a condition of obtaining and maintaining their licenses. The new law went into effect earlier this month. However, the law did not include doctors and nurses.

A suicide-prevention bill is expected to be introduced during this year’s legislative session to try again to require training for doctors and nurses.

To be clear, a state policy requiring mandatory training is not an easy solution to save lives lost to suicide. But it is a necessary step to increase prevention and intervention.

Doctors and nurses working in primary care settings need to know who is at a heightened risk for suicide, how to ask patients about suicidal thoughts and plans, how to counsel on safe storage of guns and how to manage patients who commonly struggle with mental-health disorders.

Arm doctors and nurses with the skills they need to quickly, competently, and compassionately share responsibility for suicidal patients with the mental health professionals who can provide additional needed intervention.

The state also needs to ensure there is a mental-health system ready to support primary-care physicians and nurses once they identify suicidal patients. Historically, Washington has led the way in developing systems of care where doctors, nurses and mental-health professionals are co-located, coordinated and who follow up on patients for whom there are mental health concerns.

With the Affordable Care Act, more leadership is undoubtedly on the horizon. But these types of integrated health-care systems are not available to everyone, especially in rural parts of Washington where suicide rates are the highest.

The proposed bill would provide funds to develop a psychiatric telephone consultation line and a system for regional care coordination that doctors and nurses can call for help monitoring patients with mental health concerns. It also directs Washington’s Department of Health to develop a comprehensive suicide prevention plan with realistic goals, action areas and implementation strategies. The state currently does not have such a plan to reduce suicide.

The estimated cost of implementing this legislation, $240,000, is a minuscule amount relative to the societal and economic costs of losing nearly 1,000 lives next year. This price tag does not include the cost of training for doctors and nurses; they are already expected to pay for continuing education. The legislation does not require additional training hours, only that a small proportion of those hours be devoted to suicide prevention.

Because middle-aged men represent the largest number of deaths by suicide, and because the vast majority of our military veterans do not seek treatment from the Veterans Affairs system, primary care is the front line of suicide prevention. The time to act on common sense public-safety measures, like the ones proposed in this legislation, is now. One more suicide is one too many.

Jennifer Stuber is assistant professor at the University of Washington School of Social Work. After losing her husband to suicide in 2011, she helped pass the Matt Adler Suicide Assessment, Treatment and Management Act.




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