May is National Mental Health Awareness Month, and I've asked Dr. Leslie Nona, one of the talented and passionate internists and physician leaders with St. Luke's Internal Medicine, to write about a critical health challenge of particular importance in our rural region. Her report follows.
I recently had the fortune of bumping into a colleague from my residency training days who wondered if I would be willing to take part in a statewide suicide prevention roundtable.
I told her that as a general internist, my qualifications seemed limited: admitting patients who had attempted suicide during my inpatient hospital duty; two very sad losses of my own clinic patients to suicide; and a terrifying call that I received from a suicidal patient while in clinic.
While I feel comfortable with the wide range of organ system problems of adults, it dawned on me that I know too little about this often-preventable cause of death. I agreed to join the roundtable, and I feel I learned far more than I contributed. I hope to share some information that will be helpful to everyone, particularly those of us in health care who have frequent contact with those at risk.
Here are the statistics. Suicide is the second-leading cause of death for Idahoans ages 15-34, and sadly, we have the sixth-highest overall rate in the nation – 49 percent higher than the national average.
In the past five years, 1,352 people completed suicide in this state, and far more than that attempted it; for every person who dies by suicide, 30 more attempt it. Men outnumbered women, but there was a significant peak among women between ages 35 and 64. Suicides among middle-aged people have increased 31 percent nationally in the past 10 years, according to the Centers for Disease Control. Suicide is now the fourth-most-common cause of death in that group, behind cancer, heart disease, and unintentional injury.
These deaths and attempts affect countless people, including family members, friends, coworkers, and entire communities. I believe suicide has touched many of us.
Suicide attempts in Idaho are estimated to cost $36 million annually. Suicide completions cost more than $850,000 in just the medical care for those who have attempted suicide and ultimately succumb, despite intervention, and $343 million in total lifetime productivity lost. And of course, this is nothing in comparison with the human cost.
This statistic is very meaningful for me: up to 45 percent of those who die by suicide have visited their primary care physician within a month of their death. This was true of my two patients.
And 81 percent of these had not sought prior subspecialty psychiatric help. This is magnified in the rural parts of the state, where 65 percent of people get their mental health care from their primary care provider.
I now understand how important it is that those in primary care be aware that, at any given time, 2 percent to 4 percent of their patients are having suicidal thoughts. Whether we are comfortable with it or not, we are the front line.
As emphasized by Kathi Garrett, the chair of the Idaho Suicide Prevention Council, suicide is a complex outcome, often with many paths. I try to keep this in mind. It is a process that generally happens over time, with the possibility for intervention when risk factors are considered.
What are the risk factors? Depression, substance abuse, PTSD/anxiety, chronic pain, and physical illness, especially involving traumatic brain injury.
I am now much more thoughtful about these patients, screening routinely and referring to mental health services when I am concerned.
What about the actively suicidal patient who calls in? Or your friend, family member, or neighbor?
I will be the first to tell you that I wish I had more expertise. Do I call the police? EMS?
Open since late last fall, the Idaho Suicide Prevention Hotline has made it part of its mission never to drop a call, and to provide consultation to clinics and responders.
Their number is 1-800-273-8255 (TALK), and their volunteers are very skilled at de-escalation and referral. I keep this number readily available, as I know enough to know I may need them as a resource.
I also highly recommend that providers download the Western Interstate Commission for Higher Education (WICHE) Suicide Prevention Tool Kit for Primary Care Providers. This is an excellent resource to educate and prepare clinicians and staff members.
Other helpful resources are:
I would like to thank the Idaho Council on Suicide Prevention for providing the information presented, particularly Chair Kathi Garrett and John Reusser of the Idaho Suicide Prevention Hotline. I would also like to thank my friend, Neva Santos, who asked me to join the prevention roundtable in the first place.
And many thanks to Dr. Pate for asking me to be a guest in this space as we recognize National Mental Health Awareness Month. I couldn’t feel more strongly that mental health deserves more attention in Idaho, and I am grateful for the chance to talk about this very meaningful health issue. Dr. Pate, thank you again for your interest in mental health.
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.