Michael F. Myers, MD provided tips and advice to clinicians who might be dealing with a patient contemplating suicide.
According to 2022 Centers for Disease Control and Prevention provisional data, the past year saw a record high of 49,369 suicide deaths after modest declines in 2019 and 2020.1 Michael F. Myers, MD, spoke to attendees of the 2023 Psychiatric Times World CME Conference about identifying suicide risk and effective treatments to reduce said risk.
“Our job is to assess and do what we can to save this individual from self-harm. It is an awesome task, right? But it can be exciting and very gratifying to have this opportunity to save a life,” said Myers.
Myers stressed the importance of the initial data gathering, in which he suggested following 8 steps2:
1. Identify distinctive individual suicide risk factors
2. Identify acute suicide risk factors
3. Identify protective factors
4. Evaluate medical history, including laboratory data if available
5. Obtain information from other clinical care providers
6. Interview patient’s significant others
7. Speak with current or prior mental health treatment providers, including treatment team if inpatient
8. Review patient’s current and prior hospital records
Any clinician dealing with a patient who is contemplating suicide should document as many details as possible, including: active suicidal intent, rehearsal behaviors, psychological stressors, access to means such as firearms, interpersonal factors, and protective factors.2
Myers also shared a short list of what he considers prudent clinician behaviors when dealing with a patient potentially considering suicide:
1. Systematically assess and formulate risk of suicidal behavior
2. Develop treatment plan to reduce assessed risk
3. Reliably implement treatment plan
4. Evaluate progress and revise/modify as needed
5. Recognize need for continuity of care
Myers then provided 2 examples of how to discuss suicidal ideation with patients. The first is more upfront: “I want you to look me in the eye and answer my question, ‘Are you having thoughts of suicide?’”3 The second is an analogy meant to destigmatize suicide: “Your pneumonia (depression) has worsened, you have spiked a fever (developed suicidal thinking), and that is why we need to treat you more aggressively (continue observation, medicate, admit).”
In summary, Myers shared these thoughts: “Screening tools are helpful, but never a substitute. Collateral information is absolutely key. Working collaboratively when we can with the patient makes it just so much easier.”
1. Saunders H, Panchal N. A look at the latest suicide data and change over the last decade. KFF. August 4, 2023. Accessed October 24, 2023. https://www.kff.org/mental-health/issue-brief/a-look-at-the-latest-suicide-data-and-change-over-the-last-decade/
2.Gold LH, Frierson RL, eds. Textbook of Suicide Risk Assessment and Management. APA Publishing; 2020.
3. Gabbard GO, Myers MF. Critical issues in the treatment of suicidal physicians: life-saving tips for the practicing clinician. APA Annual Meeting. May 20, 2017. Accessed October 24, 2023. https://www.hmpgloballearningnetwork.com/site/pcn/blog/critical-issues-treatment-suicidal-physicians-life-saving-tips-practicing-clinician