More Than Referrals: The Role of Primary Care in Suicide Prevention

Apr. 7, 2020 – About a third of individuals who die by suicide visit a primary care provider in the month before their death. General practitioners’ offices are therefore key settings for suicide prevention. Screening for patients who are struggling with their mental health is now more common than ever in primary care settings, increasing opportunities for detection and prevention while also bringing new challenges. If doctors and their staff aren’t equipped with the appropriate training, then patients who disclose suicide concerns could have negative experiences, discouraging them from communicating further and getting the help they need.

So how can we provide the right suicide prevention training and support for doctors to ensure that improved detection results in better care for patients? The answer lies in taking a fresh view of the role primary care can play in suicide prevention.

Primary care providers can do more than make referrals. With proper training, they can engage in four core tasks to improve suicide prevention outcomes: Connect – Assess – Respond – Extend. For each of these tasks, there is a toolbox of tactics, phrases, or small actions that can be used to convey empathy or to offer a new way of thinking to patients who disclose suicide concerns:

• Connect. Although the time available for individual patients may be short, there are skills and techniques primary care providers can use to encourage connection within that limited time-frame. For example, something as simple as sitting next to the patient rather than across from them can make them feel more comfortable and supported when talking about their concerns.
• Assess. Combining screening tools and interviewing skills to ask the right questions can help a patient feel heard and understood. Slowing down and really listening to the patient, and simply acknowledging and validating the pain they’re going through, can provide comfort and lead to improved engagement in recommended plans and treatment.
• Respond. Getting better takes time, but even in a brief visit a care provider can help a patient take important steps that will move them in the right direction. In particular, providers can work with patients or family members to identify specific situations or changes that might make the patient’s situation worse or better, and create an actionable plan to respond to these changes. Arranging for a return visit within a few days and making sure that the patient knows who to contact if distress becomes more serious can also help doctors to demonstrate their care and commitment to the patient’s mental health.
• Extend. Making effective referrals to behavioral health care includes offering both a commitment to ongoing communication and an explicit invitation for the patient to communicate if things don’t work out, or if the patient feels the referral isn’t a good match. These kinds of actions can make a real difference.

You don’t need to be a doctor, nurse, or physician assistant to support suicide prevention in primary care. You can play an important part simply by helping to spread the word that suicide prevention training exists for primary care doctors. You  can play a part in connecting primary care providers to this sort of training by reaching out to your local American Foundation for Suicide Prevention (AFSP) chapter. Many AFSP chapters are currently sponsoring primary care training in their communities through Project 2025, AFSP’s bold goal to reduce the nation’s suicide rate by 20% by 2025. Once chapters make a referral to SafeSide Prevention, which provides the training, they can remain engaged in the process by offering lunch during the SafeSide training hours, or by offering other AFSP services to the doctor’s office and its patients and community, such as the education program Talk Saves Lives, as well as postvention support for after a suicide.

The idea that mental health is just as important to a person’s well-being as their physical health is now widely accepted. It only makes sense for primary carers to be on the lookout for the mental health challenges their patients may face, and to be properly equipped to deal with those challenges when they arise.

Dr. Anthony R. Pisani is a primary care psychologist and suicide prevention researcher at the University of Rochester Center for the Study and Prevention of Suicide and at SafeSide Prevention. SafeSide is working with AFSP to achieve the goals of Project 2025. SafeSide video-based Primary CARE training provides a clear framework for responding to suicide concerns within the time and resource constraints of primary care. 

Jessica Hinkson, MLS, CSM is a senior consultant and writer who has been working with public health organizations since 2000 to apply evidence-based practices to improve their efficacy and outcomes.