For many patients, a visit with their primary care physician is a chance to access needed medical care and is an ideal setting for suicide prevention. By knowing the warning signs and risk factors for suicide, you can help prevent suicide attempts and address risk factors early on. Here’s how you can integrate suicide prevention in your practice and with your patients.
Provider's Guide to Suicide Risk Assessment
Contrary to a commonly held myth, asking patients about whether they experience thoughts of suicide does not put the thought in their mind. In fact, it typically opens the door for the patient to share their thoughts, and lets them know that you are open to listening and supporting them.
This guide offers you strategies to assess and treat patients at risk for suicidality to determine the nature of the risk and plan for the patient’s safety.
Screen for Common Risk Factors
Health factors such as:
- Depression
- Anxiety
- Substance use
- Bipolar disorder
- Schizophrenia
- Poor relationships
- Conduct disorder
- Physical pain
- Traumatic brain injury
Environmental stressors such as:
- Harassment/bullying
- Relational issues
- Job loss/unemployment
- Divorce
- Death of a loved one
- Exposure to another person’s suicide
- Prior history of suicide attempts
- Family history of suicide
- Chronic abuse
Learn more about risk factors
Know the Warning Signs
Expressing thoughts about:
- Killing oneself
- Having no reason to live
- Feeling trapped and/or hopeless
- Feeling like a burden to others
Troubling behaviors such as:
- Increased substance use
- Isolation
- Looking for a means to kill oneself
- Giving away possessions
- Changes to sleep and eating
- Increased aggression or fatigue
Changes in mood including:
- Increased depression, anxiety, shame, irritability, aggression
- Sudden improvement of symptoms
Learn more about risk factors
Debunk Myths about Suicide Prevention
Asking someone if they are having thoughts of suicide does not put the thought in the patient’s mind – it opens the door for the patient to speak without judgment.
Suicide is not just an issue that affects individuals with a mental health condition – having a plan and process for screening patients for suicidality can save lives.
Most suicides are not sudden - verbal and/or behavioral warning signs often precede attempts. Warning signs may go unrecognized, however, making your role as a healthcare provider all the more important in delivering this preventive care.
Suicide is not inevitable and suicidal ideation is not permanent. The act of suicide is often an attempt to control deep, painful emotions and thoughts, and once these dissipate, so will the suicidal ideation. Patients with suicidal thoughts and attempts can still live a long, successful life. Intervention can be a lifeline.
Learn more about suicide myths
Plan with your Patients
Safety planning using the evidence-based Safety Planning Intervention can help you collaborate with your patient in a non-threatening way. The VA offers a free mobile app that helps users identify personal coping strategies and sources of support – giving suicidal thoughts time to decrease and become more manageable. You can also print and share this template.
Establish means safety. Plan for time and space between the patient and her/his chosen means for suicide. For example, if the patient is planning to use a firearm, consider counseling them about utilizing lockboxes with the keys entrusted to a loved one for safe keeping, and/or keeping guns and ammunition separate. Research has demonstrated that people will generally not use an alternative method if their preferred method is unavailable.
The time between active suicidal ideation and attempts can often be very short (less than 10 minutes). Making the chosen means less accessible can allow for enough time for intervention and prevent the attempt.
Refer Patients to Resources and Evidence-Based Treatment
24/7 Free and Confidential Hotlines
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988 Suicide and Crisis Lifeline | Call or text 988 | Online chat
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NYC Well | 1-888-692-9355 | Text WELL to 65173 | Online chat
Behavioral Health at Mount Sinai
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212-659-8838 | More information for referring physicians
Mount Sinai Care Management
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Assistance with finding services and insurance verification | 212-241-7228 | MSHPCMReferral@mountsinai.org
Find a Provider
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Search by specialty, zip code, accepted insurance, or name | Provider Search
Printable Patient Handout
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A printable one pager of resources and phone numbers to share with your patients
Follow Up
Through this simple action, we can let the patient know that we care about them, and that their life matters.
Learn more about follow-up care
Multimedia
Blog Posts
Safety Planning for Suicide Prevention
Anitha Iyer, PhD
A Holistic Approach to Suicide Prevention: Screening Limitations and Implications for Primary Care Providers
Amy Bennett-Staub
Crises Are Not Scheduled: Four Keys to Crafting an Effective Suicide Prevention Strategy
Anitha Iyer, PhD
When Home is Not Shelter: The COVID-19 and Domestic Violence Epidemics
Anitha Iyer, PhD
Video
Special Tip Series: Suicidality – Know the Risks with Dr. Anitha Iyer
Suicidality is the tenth leading cause of death in the United States. Knowing which patients to have a deeper conversation with can save lives. Watch these short (under 1 minute) videos to know the risk factors and warning signs.
Risk Factors for Suicide
Suicide Warning Signs
Talking with Patients about Suicide
Safety Planning for Suicide Prevention
Chronic Suicidality and Cultural Barriers to Care
with Dr. Stephen Sisselman (transcript)
Suicide Prevention
with Dr. Anitha Iyer