An Open Letter to Healthcare Professionals About Suicide
By: Paul Quinnett, Ph. D.
© Paul Quinnett, Ph.D. 2011
Idaho ranks in the top 10 states for completed suicide year in and year out. The burden of suffering is even higher in the five northern counties. The Idaho rate is 16.5 deaths per 100,000, but the average in North Idaho is 25 per 100,000 - more than twice that of the rest of the country (11.5/100K).
These are not just numbers; these are your neighbors, friends,co-workers, children and, yes, patients. So let’s talk briefly about your patients.
First a few facts:
- Medical providers have been targeted as “key gatekeepers” in the 2001 National Strategy for Suicide Prevention. The IOM report Reducing Suicide, a National Imperative, also targeted medical professionals as being in a strategic position to prevent suicide, and recommended specific training to improve diagnosis and treatment of the disorders that drive suicidal behaviors.
- “Last contact” studies suggest opportunities for suicide risk mitigation interventions abound. Reports have found 50-70% of depressed persons first seek help from a primary care provider and 30% of suicide victims and attempters visit a personal physician within a month of the event.
- Depression screening is becoming the standard of practice. Suicidal thoughts, plans, and past suicide attempts are symptomatic of depression and a failure to screen for these may expose the provider to claims of negligence. If the provider uses a routine screening tool, e.g., the PHQ9, patient endorsement of the suicide item creates a requirement for further screening.
Suicide is a difficult subject. The word conjures up unpleasant images and the entire subject matter has been taboo for centuries.
Suicide, the most preventable form of death
Routine screens for suicidal thoughts, feelings, planning and past attempts can lead to better care for what, in many cases, is a patient’s least-stated chief complaint: “I want to die.”
Our patients may complain of sleep onset insomnia, headache, fatigue, and loss of appetite, but what they cannot say is how badly they wish they were dead. Vague multiple symptoms, including chronic pain, often mask depressive disorder and is common in men, the elderly, and those in professions with a high degree of social status who “can’t afford” a psychiatric, potentially career-ending diagnosis.
How else do we account for high rates of depression-related suicide in males, military personal, law enforcement and, yes, in the medical profession? It is estimated 400 doctors kill themselves every year in America, and nurses and medical students have a higher-than-average rate of depression and suicide as well.
Treat mood disorders, save lives, it’s that simple
While there are dozens of risk factors for suicide - only some of which can be mitigated - the one disorder that shows up on psychological autopsy of completed suicides again and again is an untreated mood disorder.
Would aggressive identification and treatment of depressive illness save lives? The World Health Organization says, yes, even if depression treatment is currently only 54% effective, thousands of lives would be saved worldwide.
More powerfully, I encourage you to read up on the Henry Ford Health Systems Perfect Depression Care initiative.
Basically, Dr. Ed Coffey and his colleagues at the HFHS decided that the number of suicides they should expect in their several hundred thousand covered lives each was “zero.” That’s right, zero.
Before the project began, their suicide rate was 87/100K per year from 2002 to 2005. In four years of improved training, enhanced screening procedures, better follow up, family education, and aggressive treatment, the suicide rated dropped to 22/1000K. And in the last 10 quarters data reported to the Joint Commission, not a single patient was lost to suicide.
"There's nothing unique about the strategies. Everyone would say they're doing the same thing. We assess the risk and do everything we can do to lessen that risk,” said Ed Coffey, M.D. CEO Behavioral Health Services, VP Henry Ford Health Systems.
A closer read of this program is worth your time, if only to combat any lingering pessimism that suicide is preventable. Just Google: HFHS Suicide program.
The HFHS newsletter headline reads, “Depression Care Program Eliminates Suicide.” Go ahead, Google them at “HFHS Suicide Program” see how they did it. And if they did, perhaps you can do it, too.
For all those who have lost loved ones to suicide in North Idaho, I invite you try.
About The Author
Paul Quinnett, Ph.D. is the President and CEO of the QPR Institute, a training organization dedicated to preventing suicide.
