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Excerpt from MCPAP
People who die by suicide are more likely to have seen their PCP shortly before their death than any other health professional, creating a prime opportunity to intervene and save lives. PCP’s can identify warning signs, engage patients in life-saving treatments, and maintain continuity of care for patients with suicide risk.
Patients who screen positive for depression should be screened for suicide risk. PCP’s should also focus on patients during periods of high suicide risk, such as after a discharge from a psychiatric hospital or after an emergency room visit for deliberate self-harm. Recent evidence suggests that interventions during these high-risk periods are effective in reducing suicide deaths.
Key Components of Suicide Prevention in Primary Care
1) Learn the warning signs of youth suicide
• Talking about or making plans for suicide
• Expressing hopelessness about the future
• Displaying severe/overwhelming emotional pain
• Showing worrisome behavioral cues or marked changes in behavior, particularly in the presence of the warning signs above.
Specifically significant:
Withdrawal from or changing in social connections/situations
Recent increased agitation or irritability
Anger or hostility that seems out of character or out of context
Changes in sleep (increased or decreased)
2) Develop office protocols with defined roles for all staff in the practice
• A good resource for developing a protocol is the Suicide Prevention Toolkit for Rural Primary Care Practices: www.sprc.org/webform/primary-care-toolkit
• In addition to using the tips from the toolkit, access DCPAP for consultation around suicide risk
• Contact Delaware mobile crisis hotline Child Priority Response 1-800-969-4357 under 18
3) Implement clinical suicide prevention practices including screening, risk assessment, brief intervention, referral and follow-up
Implementing Clinical Suicide Prevention Practices
• Screening – PHQ-9 or ASQ (Ask Suicide Screening Questions)
• Risk Assessment – SAFE-T or Columbia Suicide Severity Rating Scale (CSSRS)
• Brief Primary Care Intervention
• Safety Planning http://www.sprc.org/resources-programs/safety-planning-guide- quick-guide-clinicians
• Lethal Means Counseling https://training.sprc.org/
• Brief Patient Education
• Crisis Center Information Child Priority Response
under 18 1-800-969-4357
18+ 1-800-652-2929
• Rapid Referral to Specialty Care
• Follow Up
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