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Suicide Risk Assessment and Safety Planning in Integrated Primary Care Settings: Recommendations for Behavioral Health Consultants

Journal of Health Service Psychology volume 48, pages 133–139 (2022)Cite this article

Abstract

Primary care is an important setting for improving identification and treatment of people at risk for suicide. However, there are few standardized protocols for management of suicide risk in primary care. In this paper, we outline evidence-based practice considerations for behavioral health consultants (BHCs) tasked with conducting suicide risk assessments and safety planning interventions in integrated primary care behavioral health (PCBH) settings. Specifically, we highlight the importance of a nonjudgmental and direct approach to suicide risk assessment, a supportive therapeutic relationship, and a stepped care approach wherein suicide risk is managed in the least restrictive setting possible.

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References

  • Bridges, A. J., Gregus, S. J., Hernandez Rodriguez, J., Andrews, A. R., III, Villalobos, B. T., … Cavell, T. A. (2015). Diagnoses, intervention strategies, and rates of functional improvement in integrated behavioral health care patients. Journal of Consulting and Clinical Psychology, 83, 590-601. https://doi.org/10.1037/a0038941

  • Bryan, C. J., Corso, M. L., Corso, K. A., Morrow, C. E., Kanzler, K. E., & Ray-Sannerud, B. (2012). Severity of mental health impairment and trajectories of improvement in an integrated primary care clinic. Journal of Consulting and Clinical Psychology, 80, 396-403. https://doi.org/10.1037/a0027726

    Article  PubMed  Google Scholar 

  • Bryan, C. J., Corso, K. A., Rudd, M. D., & Cordero, L. (2008). Improving identification of suicidal patients in primary care through routine screening. Primary Care & Community Psychiatry, 13, 143-147. https://doi.org/10.1080/17468840802168268

    Article  Google Scholar 

  • Bryan, C. J., Mintz, J., Clemans, T. A., Leeson, B., Burch, T. S., Williams, S. R., … Rudd, M. D. (2017). Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army soldiers: A randomized clinical trial. Journal of Affective Disorders, 212, 64-72. https://doi.org/10.1016/j.jad.2017.01.028

  • Bryan, C. J., & Rudd, M. D. (2018). Brief cognitive behavioral therapy (BCBT) for suicide prevention. New York, NY: Guilford Press

    Google Scholar 

  • Center for Behavioral Health Statistics and Quality. (2021). 2020 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD. https://www.samhsa.gov/data/sites/default/files/reports/rpt35323/NSDUHDetailedTabs2020/NSDUHDetailedTabs2020/NSDUHDetTabsSect8pe2020.htm

  • Centers for Disease Control and Prevention (CDC). Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2021) National Center for Injury Prevention and Control. https://www.cdc.gov/injury/wisqars/fatal.html

  • Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide rates after discharge from psychiatric facilities: A systematic review and meta-analysis. JAMA Psychiatry, 74, 694–702. https://doi.org/10.1001/jamapsychiatry.2017.1044

    Article  PubMed  PubMed Central  Google Scholar 

  • Currier, G. W., Brown, G. K., Brenner, L. A., Chesin, M., Knox, K. L., Ghahramanlou-Holloway, M., & Stanley, B. (2015). Rationale and study protocol for a two-part intervention: Safety planning and structured follow-up among veterans at risk for suicide and discharged from the emergency department. Contemporary Clinical Trials, 43, 179-184. https://doi.org/10.1016/j.cct.2015.05.003

    Article  PubMed  Google Scholar 

  • Eynan, R., Bergmans, Y., Antony, J., Cutcliffe, J. R., Harder, H. G., Ambreen, M., Balderson, K., & Links, P. S. (2014). The effects of suicide ideation assessments on urges to self-harm and suicide. Crisis, 35, 123-131. https://doi.org/10.1027/0227-5910/a000233

    Article  PubMed  Google Scholar 

  • Ho, F. Y. Y., Yeung, W. F., Ng, T. H. Y., & Chan, C. S. (2016). The efficacy and cost-effectiveness of stepped care prevention and treatment for depressive and/or anxiety disorders: a systematic review and meta-analysis. Scientific reports, 6(1), 1-10. https://doi.org/10.1038/srep29281

    Article  CAS  Google Scholar 

  • Jobes, D. A. (2017). Clinical assessment and treatment of suicidal risk: A critique of contemporary care and CAMS as a possible remedy. Practice Innovations, 2, 207-220. https://doi.org/10.1037/pri0000054

    Article  Google Scholar 

  • Jobes, D. A., Gregorian, M. J., & Colborn, V. A. (2018). A stepped care approach to clinical suicide prevention. Psychological Services, 15(3), 243. https://doi.org/10.1037/ser0000229

    Article  PubMed  Google Scholar 

  • Leavey, G., Mallon, S., Rondon-Sulbaran, J., Galway, K., Rosato, M., & Hughes, L. (2017). The failure of suicide prevention in primary care: Family and GP perspectives – a qualitative study. BMC psychiatry, 17(1), 1-10. https://doi.org/10.1186/s12888-017-1508-7

    Article  Google Scholar 

  • LeFevre, M. L., & U.S. Preventive Services Task Force. (2014). Screening for suicide risk in adolescents, adults, and older adults in primary care: US Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 160, 719-726. https://doi.org/10.7326/M14-0589

  • Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., … Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63, 757–766. https://doi.org/10.1001/archpsyc.63.7.757

  • Luoma, J. B., Martin, C. E., & Pearson, J. L. (2002). Contact with mental health and primary care providers before suicide: A review of the evidence. American Journal of Psychiatry, 159, 909-916. https://doi.org/10.1176/appi.ajp.159.6.909.

    Article  PubMed  Google Scholar 

  • Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., … Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168, 1266-1277. https://doi.org/10.1176/appi.ajp.2011.10111704

  • Robinson, P. J., & Reiter, J. T. (2016). Behavioral consultation and primary care: A guide to integrating services. New York, NY: Springer. https://doi.org/10.1007/978-3-319-13954-8

    Book  Google Scholar 

  • Rudd, M. D. (2006). Fluid vulnerability theory: A cognitive approach to understanding the process of acute and chronic suicide risk. In T. E. Ellis (Ed.), Cognition and suicide: Theory, research, and therapy (pp. 355-368). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Sommers-Flanagan, J. (2018). Conversations about suicide: Strategies for detecting and assessing suicide risk. Journal of Health Service Psychology, 44(1), 33-45. https://doi.org/10.1007/BF03544661

    Article  Google Scholar 

  • Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19, 256-264. https://doi.org/10.1016/j.cbpra.2011.01.001

    Article  Google Scholar 

  • Unutzer, J., Tang, L., Oishi, S., Katon, W., Williams, J. W., Hunkeler, E., … Langston, C. (2006). Reducing suicidal ideation in depressed older primary care patients. Journal of the American Geriatrics Society, 54, 1550-1556. https://doi.org/10.1111/j.1532-5415.2006.00882.x

  • Western Interstate Commission for Higher Education (WICHE) and Suicide Prevention Resource Center (SPRC). (2009). Suicide Prevention Toolkit for Rural Primary Care. A Primer for Primary Care Providers. Boulder, Colorado: Western Interstate Commission for Higher Education.

  • Williams, A. J., Jones, C., Arcelus, J., Townsend, E., Lazaridou, A., & Michail, M. (2021). A systematic review and meta-analysis of victimisation and mental health prevalence among LGBTQ+ young people with experiences of self-harm and suicide. PloS One, 16, e0245268. https://doi.org/10.1371/journal.pone.0245268

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Younes, N., Melchior, M., Turbelin, C., Blanchon, T., Hanslik, T., & Chan Chee, C. (2015). Attempted and completed suicide in primary care: Not what we expected? Journal of Affective Disorders, 170, 150-154. https://doi.org/10.1016/j.jad.2014.08.037

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Johnson City, TN, USA

    Aubrey R. Dueweke

  2. Fayetteville, AR, USA

    Ana J. Bridges

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  1. Aubrey R. Dueweke
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  2. Ana J. Bridges
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Correspondence to Aubrey R. Dueweke.

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Dueweke, A.R., Bridges, A.J. Suicide Risk Assessment and Safety Planning in Integrated Primary Care Settings: Recommendations for Behavioral Health Consultants. J Health Serv Psychol 48, 133–139 (2022). https://doi.org/10.1007/s42843-022-00067-4

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  • DOI: https://doi.org/10.1007/s42843-022-00067-4

Keywords

  • Suicide risk
  • Safety planning
  • Primary care behavioral health integration
  • Integrated care