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Part 2 ? Embracing your role through screening, assessing, and promoting safety for individuals at risk for suicide

In part one of this series, we addressed your role as a health care provider in assessing the risk of suicide. Here we are offering information on how you can screen and intervene when you believe a patient is suicidal. For primary care physicians (PCP), OB/GYNs, and Behavioral Health providers (BHP), the use of screening tools can promote safety. An advantage to using screening tools is the common language that PCPs, OB/GYNs, and BHPs need to effectively communicate.¹ Below are three of the many tools you can explore for use in your practice:

• PHQ-9. One of the more familiar screening tools for depression is the PHQ-9. This tool gives vital information about depression, which is a significant contributor to an increase in the risk for suicide. Although this tool has only one question that directly addresses thoughts of suicide, it could help show that the patient is at risk. In addition, there are specific suicide screening tools available that, when used in conjunction with the PHQ-9, can explore the issue of suicidality more fully.
• SAFE-T. The Substance Abuse and Mental Health Services Administration (SAMHSA) offers several tools on their website, and many of them can be used without cost. One of these is the Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) tool, which identifies risk and protective factors, inquires about suicidal thoughts, determines risk levels, and makes recommendations for intervention and follow-up. In addition to the SAFE-T tool, you can find information on SAMHSA's website regarding the SAFE-T suicide prevention app for mobile devices.²
• Columbia Suicide Severity Rating Scale. The National Action Alliance for Suicide Prevention supports Zero Suicide and wants health care providers to see suicide as preventable. Through the Zero Suicide website, you can obtain information and education about another valid and reliable tool, the Columbia Suicide Severity Rating Scale.³ This tool can be used for screening and referral/triage by PCPs and OB/GYNs as well as a more intense assessment of suicidal ideation and suicidal behavior by BHPs.

While these and other organizations may differ on recommendations of suicide rating scales, they all reinforce that suicide is preventable and that the health care system must address it. These organizations also reinforce that healthy connectedness is a protective factor and set an expectation that health care providers communicate and collaborate on the care of individuals at risk for suicide.

The National Suicide Prevention Lifeline, 1-800-273-TALK (8255), is available for any of your patients who may be at risk.

¹Crosby AE, Ortega L, Melanson C. Self-directed Violence Surveillance: Uniform Definitions and Recommended Data Elements, Version 1.0. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2011.

²http://store.samhsa.gov/apps/suicidesafe

³Posner, K., et al. The Columbia-Suicide Severity Rating Scale: Initial Validity and Internal Consistency Findings From Three Multisite Studies With Adolescents and Adults, American Journal of Psychiatry, 2011; 168:1266-1277.

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