Download - New York State Office of Mental Health

Saving Lives in New York Volume 2: Approaches and Special Populations
A Message
to the Physicians of New York State
Regarding Their Role
in Suicide Prevention
from
Dr. William E. Tucker
Interim Chief Medical Officer (Emeritus),
New York State Office of Mental Health
A little-known fact is that more people die
by suicide than from homicide in the United
States – and New York – each year. Though
not all suicides are preventable, most who
die from suicide have made previous
attempts, and a substantial number have
consulted physicians in the weeks leading
up to the event; thus, many may be preventable,
if appropriate attention is devoted
to identifying and intervening with those at
immediate risk. (Note: Since the under-lying
biological and psychosocial causes of suicidal
behavior are addressed in the OMH suicide
prevention plan, this document will
focus only on the role of physicians in early
identification and referral).
A commonly held misconception, even
among many physicians, is that it is somehow
embarrassing to a patient to be asked
about suicidal thoughts or plans – or worse,
insulting; the patient will respond, "What do
you think I am, crazy?" An extension of this
misconception, also mistaken, is that
patients will therefore deny or conceal their
suicidal thoughts. In fact, the overwhelming
majority of patients experience considerable
relief at being asked: there is finally an
opportunity to express their terrifying concerns
to the person they consider responsible
and and most capable of providing for
their overall health. Therefore, they are
forth-coming in response to being asked.
Within this framework, three questions
immediately arise: Who are the most
appropriate professionals to pose the question?
What is an effective way to pose it?
What is the appropriate next step, if the
answer is positive?
Generalist and specialist physicians of all
types, in their role as public health agents,
make up the "front line" on this. The routine
initial or follow-up visit is the appropriate
setting for a physician to inquire about
suicide. There need be no more index of
suspicion than for any other general health
issue, such as changes in diet, activity,
sleep, discomfort, or somatic concern.
Broaching the subject can be as general
and unexceptional as that to any other
organ system. Individual styles vary, but the
question may take the form of, for example,
"Since your last visit, would you say
that, for the most part, you have been
happy with your life?" The follow-up question
is simply, "Are you saying then, that
you have or have not had any thoughts of
suicide?" A negative response is sufficient
to end the line of inquiry. If the response is
positive, it is imperative to ask: "And have
you made any plans to do something to
carry them out?"
Positive responses to inquiries about suicidal
thoughts or plans should trigger a referral
to a psychiatrist, just as positive indications
should be reffered to other systemic
pathology outside the realm of the physicians's
usual practice. It should also be
A Message to the Physicians of New York State 5