A clinical discussion on the underlooked, undertreated, and underperforming facets of a public health crisis.
Sandra Pimentel, PhD
During last week’s Suicide Awareness Week, MD Magazine® hosted a #DocTalk tweet chat with a team of psychiatry experts from Montefiore Health System on, well, suicide awareness.
Though the broad topic aligned with campaigns to raise more public awareness on the signs and eventual effects of suicide, the actual online conversations among clinicians, advocates, and experts spent time looking for solutions: what can a physician do to help after a patient suicide attempt? How does patient demographic influence their risk? What are the proper resources?
The discussion continued offline.
In an interview with MD Mag following the chat, Sandra Pimentel, PhD—chief of Child and Adolescent Psychology at Montefiore, associate director of Psychology Training, and associate professor at Albert Einstein College of Medicine’s Department of Psychiatry and Behavioral Sciences—fielded a series of questions surrounding suicide, one of the greatest and growing public health concerns in the US.
MD Mag: Studies show suicide has increased nationally for at least the past 20 years. How do we define the scope of the issue in light of other public health concerns?
Pimentel: Suicide is a public health crisis. The fact that suicide is the second leading cause of death in adolescents and young adults should alarm all of us. We are not focusing enough of our policies and funding on this issue, especially for vulnerable populations, including veterans and the LGBTQ community.
MD Mag: With increasing cases and risks, how have solutions adapted to respond to the issue of suicide? What does the current network of care look like?
Pimentel: While there’s more attention paid to suicide today, our solutions have to shift towards funding the evidence-based methods that we know work—like assessments with follow-up services (for example, a follow-up phone call, or helping a patient make their next appointment) and crisis services.
Research by Dr. Madelyn S. Gould and her team at Columbia Psychiatry has shown that suicide crisis hotlines can be effective. In a positive step forward, the FCC recently approved a 3 digit suicide crisis line (988). But the most effective methods involve some sort of follow up with patients, which requires funding.
There’s also a new initiative from the National Suicide Prevention Hotline called #BeThe1To, about how we can all take action to prevent suicide. We are all gatekeepers to health and helping people get the help that they need. We need to be training teachers, primary care docs, pastors, coaches, etc. to evaluate and be able to check in with the people they work with about mental health.
MD Mag: What role could primary care physicians play in addressing suicide, both case-by-case, and in greater numbers?
Pimentel: Physicians can administer behavioral health assessments at every visit, and generally integrate behavioral health into primary care. Primary care doctors should be trained to ask patients about depression. At Montefiore, we have made mental health care an integral part of our services through our Behavioral Health Integration Program (BHIP). At all of our primary care locations, physicians and specialists work hand in hand with a team of behavioral health practitioners.
MD Mag: If we were to adopt public health measures and clinical advances which reduced the rate of suicides in the US, and improved screening methods and outpatient care options, what would those measures and advances be?
Pimentel: We need to shift the perception of suicide from a personal failing to a public health crisis, especially for vulnerable groups. We have to treat it as public health concern with a public health response -- using policies that we know work, and evidence-based science.
We know that anti-bullying policies that specifically protect LGBTQ youth work. We know that opening up access to healthcare would help more people access mental health resources. We know we have to work to correct health disparities for vulnerable groups.
If you can limit the means for lethality in suicide, you can reduce suicide. We cannot properly address suicide unless we address firearms, as there is evidence-based research that connects firearms to suicide.
The National Suicide Prevention Lifeline’s Zero Suicide initiative is a good place to start when looking for ways that organizations can integrate safer suicide care into primary care.