Photo by Steve Shay
The King County Suicide Prevention Coalition (KCSPC) hosted a suicide assessment/intervention training seminar for primary care providers Thursday, Jan. 31, at Navos Mental Health and Wellness Center in Burien. Pictured L-R: Elaine Walsh, PhD, Associate Professor UW School of Nursing, Co-Director of the Psychiatric Mental Health Nurse Practitioner Program, Sue Eastgard, MSW, Founder, Youth Suicide Prevention Program of Washington State, & speaking is Katie Stevens, MA., Service Manager, Crisis Clinic, Seattle.

King County Suicide Prevention Coalition speak at Navos: "Doctors overlook high-risk patients"

Suicide screening would complicate the average 15-minute doctor exam

The all-volunteer King County Suicide Prevention Coalition (KCSPC) hosted a suicide assessment/intervention training seminar for primary care providers Thursday, Jan. 31, at Navos Mental Health and Wellness Center, 1210 SW 136th St.,  Burien. About 60 attended, including professionals from Highline Medical Center, including its Roxbury, White Center clinic, Sea Mar Community Health Services, also in White Center, and Swedish Medical Center in West Seattle. Most attendees were nurses.

Speakers were Peggy West, PhD, M.S.W., Senior Advisor Suicide Prevention Resource Center, Wayne Webster, M.D., M.P.H., with Navos, Sue Eastgard, MSW, Founder, Youth Suicide Prevention Program of Washington State, Elaine Walsh, PhD, Associate Professor UW School of Nursing, Co-Director of the Psychiatric Mental Health Nurse Practitioner Program, and Katie Stevens, MA., Service Manager, Crisis Clinic, Seattle.

Topics included Relevance of Training to Primary Care, Warning Signs, and others. Risk from access to handguns was emphasized, topical in the wake of the recent murder/suicide school shootings. Since December’s Newtown tragedy, mental health has taken center stage in national dialogue.
USB Flashdrives containing suicide prevention community resources and screening techniques were given to attendees to share with their staff.

Each year about 33 youths in Washington State are hospitalized and 19 die from firearm injuries, over half with a gun from the adolescent’s home. KPSCP wants gun-owners to trigger-lock their firearms.

In 2011, there were 265 suicide deaths in King County, accounting for 13-percent of all deaths.

Last year under House Bill 2366 the State House added primary care providers to the list of professions required to be trained in suicide prevention. However, after strong opposition from the physician and nursing lobbies, the Senate removed these provisions from the bill. 

"Health professionals are licensed by the state with the expectation they will protect the public, but not all clinicians receive this critical suicide prevention training,” said state Rep. Tina Orwall (D-Des Moines) in a 2012 statement responding to the bill. She said suicide is the eighth leading cause of death in Washington, higher than homicide, HIV/Aids and traffic accidents combined.

"The benefit of assessing depression and suicide risk in primary care settings is not only about saving lives, but about beginning a conversation with patients about mental health problems that may be contributing to physical symptoms," write PhD.'s Jennifer Stuber and Paul Quinnett in their article, "Making the Case for Primary Care and Mandated Suicide Prevention Education". (The American Association of Suicidology, 2013). Both are UW-affiliated, and well-known suicide prevention advocates.

Of those who commit suicide, 45 percent see a primary caregiver within a month prior to their death, 77 percent within one year.

They add, "Suicide assessment is the job of the primary care provider as suicidal patients are abundant in medical practice (...) Physical illness increases suicide risk. Studies indicate the need to integrate suicide prevention within hospital treatment as well as within general medical practice..."

Dr. West, and Lauren Davis, KCSPC Training Coordinator, discussed with the Highline Times why they believe primary care doctors are resistant to screening their patients for suicide and depression, and the dangers of keeping things status quo. Davis began Students Opposing Suicide, or "SOS" in Issaquah High School as a student after a dear friend and classmate took his life and remains committed to the cause.

"Why is there so much pushback?" Davis remarked. "Obviously primary care doctors entered these professions because they're interested in saving lives, so we as a society have to help the medical community figure out how to better care for these (at-risk) individuals. Some doctors are interested. Our group has received at least a half-dozen requests for in-house training at clinics to train the staff on-site. What the doctors and nurses are opposed to is mandatory suicide prevention training.

"Most physicians just don't receive training and don't know the wanting signs. They see a patient for 15 or 20 minutes, very minimal," said Davis, whose group encourages that everybody learn CPR to apply basic suicide "first aid."

"We want the general provider to probe (for suicide risk) if their patient says they feel sad," Davis said. "The problem is, once they get a 'Yes' in response to the question, 'Are you thinking of suicide?' then they have to document that 'Yes' and everything points to them as a provider to keep this person safe. They feel this is a big liability and takes time away from their brief visit with the patient."

Said Dr. West, "Many doctors haven't had the training, or don't have the time to work in questions that may be complicated and take time away from your exam. Not that we don't want people to go to mental health services, but people go where they go, and we know that people go to primary care."

Regarding those who feel a reluctance to intervene when a patient, or loved one may feel depressed and want to commit suicide, Dr West said, "People who feel hopeless can get better. There are many people who have made very serious attempts at suicide and survived who never attempt it again. They go on to have productive lives. It's not a hopeless situation."

There is an 80-90 percent recovery rate for those treated.

The KCSPS recommends certain resources for at-risk individuals they say are not widely known in the medical community, including "Next Day Appointment", a crisis resource for those 18 years and older. These are scheduled with a Public Community Mental Health Provider.

Also, the Children’s Crisis Outreach & Response System, (CCORS), through the YMCA of Greater Seattle for ages 3-18 years old (and their accompanying family) experiencing a mental health crisis in King County, and not current receiving services though a King County Mental Health Provider

For a "Next Day Appointment" and CCORS, individuals can use their Crisis Line 24/7 for immediate support by calling (206) 461-3222.

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