88 Time November 4, 2019
answers to a short depression questionnaire
to predict who’s most at risk in one of their
mental-health clinics. (They plan to later ex-
pand to primary care.) When analyzed to-
gether, this data—which includes strong
predictors like a person’s mental-health di-
agnoses and substance-use history—can in-
stantly flag patients who are most at risk for
suicide to a “surprisingly accurate” degree,
says Dr. Gregory Simon, a psychiatrist and
researcher at Kaiser Permanente Washing-
ton. Once it’s implemented, when at-risk pa-
tients have a doctors’ visit, their provider will
be alerted to assess their risk for suicide. And
if they don’t show up, someone will reach out
to them.
Once clinicians know whom they should
be targeting, they can begin to intervene. One
effective way to keep people safe from suicide
is to take guns, pills or other lethal means
out of their homes through discussions with
patients and their families. “Most people
who might be thinking of ending their lives
have a particular means in mind,” says Mike
Hogan, a suicide- prevention expert. “Ending
your life is hard—it’s hard psychologically,
and it’s hard physically—and if you take
that one means away, most people won’t do
something else.”
Without the tools to carry out a plan, “if
you can ride the wave a day or two, when the
thoughts are at their most powerful, then the
thoughts begin to abate,” says Julie Goldstein
Grumet, director of health and behavioral-
health initiatives for the Suicide Prevention
Resource Center. “If you can really increase the
time and the distance between the thoughts
and the access, then we know the rates of sui-
cide will go down.”
Knowing how to fill that time is crucial.
That’s where a safety plan—a guide that a pa-
tient and a provider write together, detail-
ing what the person can do and who they can
call when they’re in suicidal crisis—has been
shown to be valuable. “We have typically
worked on the development or implementa-
tion of more complex treatments for suicidal
people,” says Barbara Stanley, co-developer of
the safety planning intervention and profes-
sor of medical psychology at Columbia Uni-
versity Irving Medical Center. “And here you
find something that is incredibly simple, very
easy to train, pretty easy to implement, yet it
seems to get just as good results in preventing
suicide.” Health systems are rapidly adopting
safety plans because of their simplicity and ef-
ficacy. Safety planning is now standard at every
VA medical center.
there are signs that health systems across
the country will soon step up their suicide
care. In July, the Joint Commission, the major
accreditor of health care organizations in the
U.S., imposed new rules requiring hospitals
and behavioral- health centers to approach
suicide prevention more systematically, with
enhanced screening and improved coun-
seling and follow-up care when at-risk pa-
tients leave care. “It used to be our standards
were to refer someone to a suicide hotline,
and that’s just not the state of the science at
this point,” says Dr. David Baker, executive
vice president for health care quality evalu-
ation at the Joint Commission. The Veterans
Health Administration, the country’s largest
integrated health care system, has long priori-
tized suicide prevention but is also raising the
bar; in 2017 it started offering same-day ac-
cess to mental- health services across the VA,
and in 2018 it began screening everyone for
suicide risk. SAMHSA is funding $46 million
in grants to help health systems implement
suicide prevention and intervention pro-
grams. And researchers are currently testing
how effective these types of interventions are
at reducing suicides on a much larger scale:
across six health care systems, including sev-
eral Kaiser Permanente sites. It is one of the
largest mental- health studies of all time.
It might seem perverse that health care
organizations don’t already prioritize sui-
cide care. But for the most part, they don’t.
“This whole notion of preventing suicide is
quite radical,” says Dr. Justin Coffey, chair of
the department of psychiatry and behavioral
health at Geisinger Health System. “For many
of us, it’s antithetical to what we were taught
in our clinical training. Suicide is tradition-
ally understood as this tragic yet inevitable
outcome of serious mental illness.” The old
thinking was that you couldn’t stop people
who have decided to kill themselves, so most
providers received no formal training on how
to care for suicidal patients. “And yet now we
know it is indeed preventable,” Coffey says.
This shift in thinking—and the hands-on
approach now gaining traction—has its foun-
dation in work started nearly 20 years ago.
In 2001, the behavioral- health department
of the Henry Ford Health System in Detroit
remade itself around the goal of completely
eliminating suicide among its patients, using
science-backed techniques like giving them
quicker access to care and keeping in closer
contact with them. Within two years, sui-
cide rates among these patients dropped by
more than 75% (and remained as low for over47,17 3
The number of Americans who
died by suicide in 2017$94
billion
The estimated annual cost
of attempted and completed
suicides in the U.S., due to lost
work and medical expenses75%
The drop in the suicide rate
among patients in a system
that implemented a more
hands-on approach