Two Paths, One Mission: How Shared Experiences Inspired a New Suicide Prevention Education Program for Medical Professionals

This article discusses the origin of the American Foundation for Suicide Prevention’s education program “Clinical Approach to Preventing Suicide: An Introduction” (CAPS), designed for health care providers and those in training, such as physician assistant (PA) students, nurse practitioner (NP) students, or physician residents.

Lisa Riley: 

I was still in my first month as a full-time graduate level faculty member for a PA program in Boston when I realized there was no education included that focused on suicide prevention or even how to talk about suicide. Where and how would the students be instructed to ask their patients about thoughts of suicide? I knew this should be part of the process of taking a patient’s history, because research shows suicide is often preventable, and that over 40% of those who die by suicide see a medical provider in the month before their death. So, this is an opportunity I knew should not be passed up. 

Meeting Ali Walker at an AFSP Chapter Leadership Conference changed my life. She was “me,” for the most part, but much younger. Ali was passionate about the PA profession, was a highly skilled provider, and had a great sense of humor. Also like me, she had lost someone to suicide.  

Ali Walker: 

I started my career in health care 13 years ago as a respiratory therapist and newly bereaved suicide loss survivor. I was struck by the widespread lack of comfortability with suicidal patients. This observation continued through my journey of training and practicing as a PA.   

Our training prepares us intensively for cardiovascular emergencies like heart attack and stroke, but do clinicians recognize the signs of suicidal crisis? Further, do they know what to do when they encounter someone at risk? 

Although nearly a quarter of Americans experience depression, medical training on suicide — the worst psychiatric outcome — has been lacking. Research spanning more than a decade has shown that limited training contributes to under-recognition of suicide risk, and when risk is identified, many providers (i.e., physicians, PAs, NPs) are uncertain about what to do. Not only is this troublesome for patients, it’s distressing to providers, too. We sought careers in a helping profession, and nothing scares us more than feeling like we’re failing our patients. 

I had earlier partnered with my program faculty and medical school administrators to host a series of lectures and multidisciplinary discussions around care for patients at risk for suicide. It was a good start, but it didn’t feel big enough. And then, I met Lisa.  

She shared my passion for linking medical education to suicide prevention. We were on the same mission, honoring our friends by helping others and empowering our colleagues to join us in the fight to stop suicide.  

Lisa: 

Within minutes of our meeting, we were planning our attack. We wanted to create a lecture in which providers (i.e., physicians, PAs, and NPs) and providers-in-training could learn about suicide, in much the same way they learn about physical health conditions, such as hypertension or diabetes. They would learn epidemiology (i.e., understanding when, where, and why a disease or disorder happens within a population), risk factors, clinical presentation, diagnostics, treatment, and patient education: all the components of any clinical medicine lecture.  

We began to put together a team of PA educators. We wanted to pull from our own experience to design the lecture like every other medical lecture we create. But we also needed a partner, not only to ensure the latest thinking on suicide prevention, but also to help us scale the program and ensure that it reaches the most people possible.  

Naturally, we thought of the American Foundation for Suicide Prevention.  

Ali: 

Thanks to the insight of experienced colleagues, experts from the American Foundation for Suicide Prevention, and the time of dedicated volunteers, our program “Clinical Approach to Preventing Suicide: An Introduction” (CAPS) was brought to fruition. It provides prescribers treating adult patients with a framework for suicide prevention in the same way our training models have traditionally approached other major health problems. The presentation begins with background information about suicide as a complex public health concern, outlining the impact of suicide across the U.S. and exploring the pathophysiology of suicidal crisis.  

What makes this program stand out is what follows: an in-depth discussion around the evidence-based tools available to assess suicide risk, guidance on how to talk about suicide with patients, and a deeper conversation about navigating treatment options known to be effective in combating suicide. 

We piloted the program across several university PA programs, at various hospitals, and among a broad array of practicing clinicians including non-prescribers (e.g., nurses, physical and occupational therapists, etc.). We were fortunate to also collaborate with the American Academy of Physician Associates, presenting our program during their annual conference and enabling us to reach a diverse audience of practicing PAs.  

Lisa: 

The data we’ve collected through the pilot has validated the need for a program like this: more than half of all respondents, including two thirds of providers (i.e., physicians, PAs, NPs), reported having never received training in suicide prevention. After attending the program, respondents’ comfort asking patients directly about suicidal thoughts and behaviors tripled. Nearly all participants reported gaining new knowledge, most often citing safety planning (79%) and suicide-specific treatment options (71%).  

At a time when access to mental health care remains a challenge for many patients, educating providers on how to recognize and treat the signs of suicide risk is critical. Our data encourages us that resources like this program can meaningfully broaden the safety net for struggling patients by ensuring more health professionals know what to look for, how to ask about suicide in a way that encourages honesty and trust, and which treatments are most effective.  

Ali: 

We are excited to offer this free program through AFSP to health professional audiences caring for adult patients across the country. Please help us stop this leading cause of death by bringing CAPS to your place of clinical practice, training program, professional organization, or other clinical audience.  

Learn more about “Clinical Approach to Preventing Suicide: An Introduction” (CAPS) and how you can bring it to your community.  

Lisa Riley MPH, PA-C, DFAAPA is a full time Assistant Professor in the Physician Assistant Studies program at MCPHS in Boston and is a Distinguished Fellow of the American Academy of Physician Associates. 

Ali Walker, DHSc, PA-C, RRT is a practicing critical care medicine PA and an Adjunct Instructor at the George Washington University Physician Assistant Program in Washington, D.C.