Suicide is a societal epidemic and a staggering public health crisis. In 2021, someone died by suicide every 11 minutes in the United States, according to the Centers for Disease Control and Prevention. This rate equates to approximately 50,000 Americans each year. An additional 1.7 million people attempted suicide in 2021, and more than 12 million more reported suicidal thoughts.
Future doctors are often unprepared to work with suicidal patients
by aparodyoflife ·
However, most medical schools do not adequately address the topic of suicide, leaving new doctors ill-equipped to identify, evaluate, and refer suicidal patients for treatment.
But there is a growing movement toward addressing mental health issues at medical schools, including Florida International University, where all three of us are associate professors of psychiatry and behavioral health.. Our program prioritizes training a new group of clinicians who will be prepared and motivated to discuss suicide with their patients. Changes can be as simple as teaching medical students to be non-judgmental and removing the stigma surrounding the subject.
When someone commits suicide, the phrase “committed suicide” is often used, as if it were a sin or a crime. This is partly because historically most religions have viewed suicide as a sin and, as a result, it has been treated as taboo.
The verb “commit” in the context of suicide can Suggests a criminal act. In contrast, using language like “died by suicide” or “committed suicide” is less stigmatizing and more neutral, which is why mental health advocates recommend these phrases as best practices.
Because of the stigma surrounding suicide, medical schools do not provide budding doctors with the language, comfort, and skills necessary to recognize and properly address suicide with their patients.
The suicide rate reached a record high in 2022 but has declined among young people
The first point of contact for patients seeking treatment for mental health conditions is usually their primary care physician. About 44% of those who died by suicide worldwide visited their primary care provider within one month of their death.
Why do so many Americans commit suicide shortly after seeing their primary care provider?
There are a combination of factors, including the persistent stigma of mental health problems, limited access to mental health professionals and the fact that primary care providers end up being the first point of contact with the patient. A 2023 study found that nearly one-third of patients received mental health care from their primary care provider.
Many of these doctors do not notice the signs of suicidal ideation. It is also possible that doctors simply do not have the time to spend with patients, even when intervention is needed. Many doctors who are not psychiatrists are also unwilling or uncomfortable to discuss suicide and are not trained to ask crucial questions about suicide.
At Florida International University, where we are associate professors of psychiatry and behavioral health, we train all medical students, starting in the first year, how to discuss suicide with patients. This helps normalize the subject as just another part of their medical training, which in turn destigmatizes it.
Then we emphasize the necessity of comfort and familiarity with the subject, as well as the many myths surrounding it. For example, there is a misconception that asking a patient about suicide will increase the likelihood that they will act suicidal. Research suggests otherwise.
Finally, students are told that doctors must create a safe environment for their patients to be open about discussing sensitive topics. In short, clinicians should ask questions about suicide in a way that is not belittling or belittling. They should not apologize to the patient or be ashamed of the topic.
Statements like “I’m sorry I had to bring this up” or “I’m sorry if this question seems too personal” can be an indicator of irritation or discomfort. Instead, doctors should ask direct, specific questions such as: “Have you had any thoughts about ending your life?” or “Do you have any thoughts of suicide?”
After completing a risk assessment, the patient will be admitted to hospital if they are at risk – there is no mandate for doctors to report or act on depression.
Although universal suicide screening practices have not yet become national best practices, there are several reasons why a standard screening process may be beneficial. Training in suicide assessment and prevention could be made mandatory for medical licensure renewal, which may include comprehensive screening practices.
For example, adopting best practices could include offering suicide screening during routine health care visits to identify people at risk who may not otherwise be identified.
Another example: More than half of the 15,000 children and teens seen in a children’s hospital emergency room for nonpsychiatric reasons between March 18, 2013, and December 31, 2018, were also experiencing suicidal thoughts and behaviors. These examples underscore the urgent need to train clinicians in suicide assessment and prevention. Currently, there is Only nine states require any training in suicide assessment and prevention in order for doctors to renew their medical licenses.
In addition, doctors can use empathy, compassion, and a non-judgmental approach, rather than making the patient feel like they are being interrogated by an attorney. Reacting empathically makes the patient feel more understood and comfortable when revealing sensitive information.
If you or someone you know is thinking about suicide, please Call or text 988 for free, confidential support.
Rodolfo Bonin is Associate Dean for Corporate Knowledge Management at Florida International University. Leonard M. Gralnick is chief education officer and chief medical officer at Florida International University, and Natalie Chois Desmarais is associate dean for student success and well-being. All three are associate professors of psychiatry and behavioral health at the school.
This article was produced in collaboration with theconversation.com.