SUICIDE PREVENTION STRATEGIES

Effective suicide prevention is a comprehensive undertaking requiring the combined efforts of every healthcare provider and addressing different aspects of the problem. A model of this comprehensive approach includes:

• Identifying and assisting persons at risk. This may include suicide screening, teaching the warning signs of suicide, and providing gatekeeper training (see below).
• Ensuring access to effective mental health and suicide care and treatment in a timely manner and coordinating systems of care by reducing financial, cultural, and logistical barriers to care.
• Supporting safe transitions of care by formal referral protocols, interagency agreements, cross-training, follow-up contacts, rapid referrals, and patient and family education.
• Responding effectively to persons in crisis by ensuring crisis services are available that provide evaluation, stabilization, and referrals to ongoing care.
• Providing for immediate and long-term postvention to help respond effectively and compassionately to a suicide death, including intermediate and long-term supports for people bereaved by suicide.
• Reducing access to lethal means by educating families of those in crisis about safe storage of medications and firearms, distributing gun safety locks, changing medication packaging, and installing barriers on bridges.
• Enhancing life skills and resilience to prepare people to safely deal with challenges such as economic stress, divorce, physical illness, and aging. Skill training, mobile apps, and self-help materials can be considered.
• Promoting social connectedness and support to help protect people from suicide despite their risk factors. This can be accomplished through social programs and other activities that reduce isolation, promote a sense of belonging, and foster emotionally supportive relationships.
  (SPRC, 2020a)

Public Health Suicide Prevention Strategies

The Centers for Disease Control and Prevention “Suicide Prevention Resource for Action” details the strategies based on the best available evidence to help states and communities prevent suicide.

• Strengthen economic supports
• Strengthen household financial security
• Stabilize housing
• Create protective environments
• Reduce access to lethal means among persons at risk of suicide (see below)
• Reduce substance use through community-based policies and practices
• Improve access and delivery of suicide care
• Cover mental health conditions in health insurance policies
• Increase provider availability in underserved areas
• Provide rapid and remote access to help
• Create safer suicide care through systems change
• Promote healthy connections
• Promote healthy peer norms
• Engage community members in shared activities
• Teach coping and problem-solving skills
• Support social emotional learning programs
• Teach parenting skills to improve family relationships
• Support resilience through education programs
• Identify and support people at risk
• Train gatekeepers (see below)
• Respond to crises
• Plan for safety and follow up after an attempt
• Provide therapeutic approaches
• Lessen harms and prevent future risk
• Intervene after suicide (postvention) (see below)
• Report and message about suicide safely
(CDC, 2022d)

GATEKEEPER TRAINING PROGRAMS

Gatekeeper training (GKT) is one of the most widely used suicide prevention strategies. It involves training people who are not necessarily clinicians to be able to identify individuals experiencing suicidality and refer them to appropriate services. GTK improves people’s knowledge, skills, and confidence in helping those who experience suicidal ideation and enhances positive beliefs about the efficacy of suicide prevention (Hawgood et al., 2023).

One example of gatekeeper training, QPR, involves three steps—Questions, Persuade, and Refer—that can be learned in as little as two hours (Purdue University, 2022).

THE AMERICAN RESCUE PLAN ACT OF 2021

The American Rescue Plan Act of 2021 includes over $3 billion to support improved mental health care. The bill includes $50 million to support and promote the mental health of healthcare professionals. Without having a basic understanding of the issues involved in the mental health of nurses, interventions will not be effective unless leaders undertake a fundamental transformation of nurses’ work environments to mitigate stressors and restore the joy in doing the work of nursing. A nursing workforce that is supported, safe, and healthy will provide many benefits to our society (Lee & Friese, 2021).

HEAR PROGRAM FOR NURSES

The Healer Education, Assessment, and Referral (HEAR) program for nurses is designed to help managers respond to situations that may bring about stress in their staff. Managers receive training on how to run emotional debriefings. Such debriefings can help staff communicate with each other about stressful situations they have experienced.

This program uses an anonymous method to provide proactive screening focusing on identifying, supporting, and referring nurses for untreated depression or suicide, as well as providing education (Davidson et al., 2021).

Strategies for Prevention of Suicide by a Colleague or Coworker

When a colleague is experiencing a mental disorder or suicidal ideation despite direct or indirect signs, the following strategies can be helpful to handle this type of situation:

• Be aware that silence does not help the health professional in trouble.
• Avoid “corridor” discussions and find a quiet, private place to talk without interruptions.
• Try to be empathic, nonjudgmental, and nonstigmatizing.
• Underline the benefits of early help-seeking as a healthy coping strategy.
• Focus on the coworker’s strengths and competencies.
• Offer advice on alternatives for appropriate treatment or help, including free, easy access, and confidential programs that may help the person overcome initial resistance to obtaining appropriate treatment.
• If a coworker may be in immediate danger of suicide, call to ask for immediate assistance.
  (Draquehais & Vargas-Cáceres, 2022)