The Journal of the Arkansas Medical Society Med Journal March 2019 Final 2 | Page 13

AFMC: A CLOSER LOOK AT QUALIT Y
definite shift from the traditional
training of “refer for consult.”
Research has provided increas-
ing knowledge about the under-
lying mechanisms of suicide and
suicidal behavior, who is at risk
for suicide and how to intervene.
The key message for all practi-
tioners is: Suicide is preventable.
Integrating behavioral health care
into an individual’s overall wellness
plan is a first step to suicide preven-
tion. Be willing to ask the suicide ques-
tion and work towards mental health
“checkups” as part of the wellness visit,
like blood work and blood pressure.
Contrary to the once popular myth,
asking about suicide does not plant
the idea in a person’s head. Interviews
with attempt survivors (known as
those with “lived experience”) indicate
that being asked about suicide in a
concerned manner often provides
some relief. 5 In her suicide research,
Ursula Whiteside, PhD, states, “Many
described feeling that they weren’t
listened to or understood and this,
in itself, was driving their suicidal
thoughts.” Think of the patient with
chronic physical pain that is so poorly
controlled or long-standing that it
affects every area of their life. When
the physician acknowledges this
suffering, it does not make the pain
subside, but it potentially creates an
atmosphere of trust and opens an
opportunity to begin a new treatment
plan. Similarly, the person thinking of
suicide needs to be acknowledged.
By utilizing the chronic disease
model, suicide prevention can be
treated in health care systems like
we treat any chronic disease. Risk is
managed by providing interventions
to decrease risk. For example, there
are well-known risk factors for heart
attack and having a subsequent heart
attack. Applying this same model can
provide a suicide prevention frame-
work. It can help reduce feelings of
being overwhelmed at the prospect
of taking a more pro-active role in
patients’ mental health care.
Patients with a history of mental
illness or substance use disorder
(SUD) should be on your radar to
assess increased risk factors. On
the other hand, there are patients
in acute distress with no history of
mental illness or SUD. A PCP visit may
reveal a recent significant life stressor
which subsequently triggers a mental
health screening or conversation with
the patient.
Risk status would include such
things as a history of bipolar disorder,
major depression, SUD, traumatic
brain injury, and serious physical
health conditions including pain, pre-
vious suicide attempts or middle age.
These risk factors cannot be changed
but provide a general guideline to use
regarding who may be at risk.
How much a person’s risk level
increases at any point is referred to
as “risk state.” If a patient’s life drasti-
cally changes due to recent changes
in marital status, job loss, grief or
situational stressors, the risk state
increases. These subgroups often
have an undiagnosed underlying low-
level depression or anxiety disorder.
When a life stressor complicates their
emotional health, the risk state rapidly
declines. Assessing mental health as
part of every visit can potentially lead
to detection and better outcomes.
Every person with suicidal
thoughts does not require psychi-
atric hospitalization, but action is
indicated. Action can include, but
is not limited to, securing a safety
plan and means reduction for each
care setting (i.e., arrange and con-
firm removal or reduction of lethal
means). The safety plan should
include the National Suicide Pre-
vention Lifeline number (1-800-273-
8255) and the crisis text line (741741
text TALK). Additional protective
factors include follow-up phone calls
to check on at-risk patients, verifying
and encouraging follow-up appoint-
ments with a mental health provider,
and collaborating with patient’s
family and friends (as patient allows
and including a release of informa-
tion) to discuss the safety plan. 6
Suicide prevention is everyone’s
business. All physicians can be inte-
gral in this public health challenge by
thinking of the three As: awareness,
assessment and action. 7 As practi-
tioners become more aware of the
problem and are better equipped
to assess it, they are poised to take
lifesaving actions. s
Ms. Bell is an outreach specialist with
AFMC. Dr. Gathright is associate
professor, psychiatry, and director,
faculty wellness at UAMS.
REFERENCES
1. Christine Moutier MD, American
Foundation for Suicide Prevention.
2. Centers for Disease Control and Prevention
(n.d.)
3. American Foundation for Suicide
Prevention (n.d.) Retrieved from afsp.org/
statistics
4. Ahmedani BK, Simon GE, Stewart C, et.al.,
Health care contacts in the year before
suicide. Jour of General Internal Medicine,
29(6), 870-877.
5. Whiteside, Ursula, PhD (n.d.) Learning from
those with lived experience. Retrieved from
afsp.org
6. National Action for Suicide
Prevention. Retrieved from
actionallianceforsuicideprevention.org.
7. The Morris Center, 2001. Survivor to Thriver
Workbook, pg. 19.
AFMC WORKS COLLABORATIVELY WITH PROVIDERS,
COMMUNITY GROUPS AND OTHER STAKEHOLDERS TO
PROMOTE THE QUALITY OF CARE IN ARKANSAS THROUGH
EDUCATION AND EVALUATION. FOR MORE INFORMATION
ABOUT AFMC QUALITY IMPROVEMENT PROJECTS,
CALL 1-877-375-5700 OR VISIT AFMC.ORG.
MARCH 2019
NUMBER 9
MARCH 2019 • 205