Talking Suicide Prevention with Dr. Boudreaux, part 3 of 4
This is the 3rd of a 4-blog post series where Dr. Edwin Boudreaux chats with us about his work recently highlighted by NIH: HEAL Research Spotlight, Taking Suicide Prevention into Primary Care Settings.
Read part 1 here and read part 2 here.
About Edwin D. Boudreaux, PhD:
Dr. Boudreaux approaches the challenge associated with solving seemingly intractable barriers to deliver high-quality behavioral healthcare by working with interdisciplinary teams who have complementary expertise and perspectives and figuring out the right balance between human centered approaches and the use of technology to facilitate workflow.
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Have you received feedback from providers about the process you’ve put in place?
We’re still in the middle of rolling it out. When we piloted it, we had a range of responses. We’ve had some very positive responses in fact, we’ve had providers tell us “we’re so glad that we finally have something that we can do with a patient who we are afraid might have suicide risks.”
The guidance is very usable and it’s very practical. Some people have thought that it is exactly what they needed; it was an unmet need that they recognized for a long time. Then we have people who are overwhelmed by the “ask”, mostly I think because they think that what we’re trying to promote is another screening activity. In primary care there is a huge screening burden, they’re responsible for screening for a bunch of behavioral, public health, social health, and medical problems. So they already feel, justifiably, overwhelmed with the amount of screening that needs to be done and I think many providers interpreted what we were asking as “now we have to screen all our patients with a new screener” when actually that was not what we were asking. I think most of the time when we experience resistance, it is because of the way the request was presented. I work with the physicians who have a reaction like: “I just can’t do another screening “and explain to them that we’re not asking them to do another screening, we’re only asking to do a screening with patients that already have a risk factor for suicide. This includes patients who are being treated for behavioral health disorders or patients who screen positive on a depression screener; the PHQ9 is the most common depression screener and item 9 is a suicide risk item. They are administering the PHQ9 already, so if item 9 is positive, they need to do something about that. What we’re doing is providing them what they should do.
Before they were calling the behavioral health provider to come in and if they didn’t have one they would just kind-of wing it, or they would send the patient to the ED. Neither of those are really good options. Whenever I reframe it, and they understand that I’m not asking them to screen patients that they don’t already recognize they should be screening, most providers recognize treating a patient with a behavioral health disorder, means they should pay attention to suicide risk. Not only because it’s the right thing for the patient but for medical legal liability risk. If you’re treating a patient for depression or anxiety disorder, and the patient dies of suicide and you didn’t screen them for suicide risk - that’s a problem from a medical legal standpoint. So, whenever I explain this to them, usually a provider will say “Oh OK, now I understand, not a problem.“ Most of the resistance is just misinformation or misunderstanding.
I do want to say that it would be ideal to screen patients who aren’t being treated for mental health problems. The fact is we under-recognize and under-identify mental health problems in primary care, and therefore, those at risk of suicide. Many of those patients, the patients who die by suicide, did not receive any help for their mental health. At this point, that is not what we’re asking, we’re just asking to do a better job with the patients that have a primary risk factor.
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In our next and final blog post from this series, Dr. Boudreaux talks with us about the connection between suicide prevention and Opioid Use Disorder.
Resources:
https://zerosuicide.edc.org/
https://zerosuicide.edc.org/sites/default/files/suicidesafercareguideforprimarycareproviders.pdf
Edwin D. Boudreaux, PhD
Edwin.Boudreaux@umassmed.edu
Professor, Depts. of Emergency Medicine, Population & Quantitative Health Sciences, and Psychiatry
Executive Vice Chair for Research, Dept. of Emergency Medicine
University of Massachusetts Chan Medical School
