Takeaway
Clinicians must proactively identify patients at risk of suicide. A multi-faceted approach includes regular screenings for depression, anxiety, and suicidal thoughts, and ensuring all patients and caregivers have access to a crisis hotline.
Lifelong Learning in Clinical Excellence | July 29, 2024 | 2 min read
By Joanna Cohen, MD, Johns Hopkins Medicine
When Dr. Smith received a call from the local emergency department, she was heartbroken to learn that one of her patients, a teenager, had attempted suicide. He’d been struggling with depression and bullying at school, but his parents had no idea he was in such deep distress. Fortunately, after treatment for his acute ingestion of acetaminophen, he survived and recovered. The incident served as a stark reminder of the importance of early intervention and comprehensive care in preventing youth suicide.
Who’s at risk?
Individual, relationship, and societal factors can all contribute to the risk of suicidal behaviors. A history of mental illness, such as depression, prior suicide attempts, and substance abuse are all known risk factors. People experiencing social isolation or bullying are also at increased risk for suicide, as are those with adverse childhood events, a family history of suicide, or family and/or peer conflict. Unsafe media portrayals of suicide, systemic trauma or marginalizing experiences, such as those experienced by some racial or ethnic groups and members of the LGBTQ community can also increase risk. The risk of completing suicide is increased by access to lethal means.
What can we do?
1. Implement routine screening for depression, anxiety, and suicidal thoughts during clinic visits. Conduct thorough assessments for suicide risk factors, including a family history of mental health issues, previous suicide attempts, trauma, and bullying.
2. Educate parents and caregivers on the importance of securing firearms, medications, and other potential means of self-harm. Firearms should always be stored unloaded, locked, and separate from ammunition. Parents should use gun safes or lock boxes and ensure that keys or combinations are not accessible to children. Educating parents on the risks of unsecured firearms can significantly reduce the likelihood of accidental or impulsive harm.
3. Encourage strong family connections and open communication between children and their caregivers. Collaborate with teachers and school counselors to monitor the child’s behavior and provide support. Work with schools and communities to create anti-bullying programs and ensure a supportive environment for children.
4. Provide access to evidence-based therapies, such as cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT). When appropriate, prescribe and manage medications for underlying mental health conditions.
5. Ensure all patients and their families/caregivers have access to crisis hotlines and mental health resources.
6. Develop safety plans for those identified as high-risk, including steps to take during a crisis.
7. Schedule regular follow-up appointments to monitor the patient’s mental health and progress.
8. Connect patients and families/caregivers with community resources, support groups, and ongoing mental health services.
9. Encourage a healthy lifestyle, including proper nutrition, exercise, and sleep. Promote involvement in positive activities, such as sports, arts, and community service.
By implementing these strategies, clinicians can play a vital role in preventing suicide and supporting overall mental health and well-being.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.