Takeaway
Primary care clinicians play a critical role in suicide prevention. Universal screening can help identify risk early and connect patients to life-saving support when indicated.
Lifelong learning in clinical excellence | June 26, 2026 | 2 min read
By Reshma Pahwa, research assistant, Laura Prichett, PhD, MHS, and Tina Kumra MD, MPH, Johns Hopkins Medicine
A discharge note from the hospital hit our triage basket detailing a patient’s recent attempt at suicide. She was a longtime patient at our practice and her mom had died the previous month. She’d been sleeping with the ashes. The last time we saw her, at an annual physical, her mom’s health was deteriorating. The patient whispered, “I don’t know what I will do if I lose my mom.”
Suicidal ideation is becoming more common in adolescents and young adults. Notably, the majority of patients have a visit with their primary care doctor in the year before they die by suicide. This made us think critically at our practice about how to intervene at the right moment.
A systems analysis approach
Using the Systems Analysis and Improvement Approach (SAIA), we examined our current workflows and aimed to create an improved and streamlined process where every patient at their annual physical would be screened, assessed, connected to treatment and referred to appropriate services as needed, and given ongoing follow-up care. As a team, we’re designing a stronger bridge between vulnerable patients and mental health resources.
Five things we’ve helpful to reduce suicide in the primary care setting:
1. Universal screening
Use a validated tool like the Patient Health Questionnaire (PHQ) or Ask Suicide-Screening Questions (ASQ) to screen for suicide ideation or planning.
2. Triage
Use a Brief Suicide Safety Assessment (BSSA) or other acuity evaluation to determine the urgency of the patient’s presentation.
2. Referral and/or treatment
Refer to mental health and/or initiate treatment based on level of urgency determined during the triage.
3. Follow up care
Follow up on completed mental health visits and coordination of care.
4. Safety plan
Create a documented safety plan that includes emergency resources.
A few more tips for clinicians:
1. Use a systematic, compassionate approach to help reduce suicides and save lives.
2. Ask questions about suicide and use screening tools—some patients are willing to write out what they’re not willing to say.
3. Mental health providers and other clinicians can help patients create safety plans, as can nurses and social workers.
4. Use culturally sensitive, nonjudgmental communication to reduce stigma and create a safe environment for patients to discuss suicidal thoughts.
A team-based approach works best in busy settings to identify patients at risk of suicide, refer them to treatment, coordinate their care, and develop safety plans to help them in times of crisis.
This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.