Testing the Impact of a Suicide Prevention Program

Does facilitated, long-term suicide prevention training leave primary care providers better equipped to care for kids facing mental health crises?

Over the last 20 years, Bruno Anthony, PhD, Chief of Psychology for the Pediatric Mental Health Institute at Children’s Hospital Colorado, has carefully watched as a pattern emerged — one that has driven mental health specialists all over the country toward creative, evidence-based action. In people between the ages of 10 and 24, suicide rates have increased nearly 60%. The lifetime prevalence of suicidal ideation has grown to 12%, and 4% to 5% of adolescents have attempted suicide. 

These statistics, and many others, have been widely shared to draw attention to the growing youth mental health crisis, but recently, Dr. Anthony has homed in on one particular data point as a key area of potential change: “Of the kids who died by suicide, 45% saw a primary care provider within the month prior to their death,” he says. “What I felt was really important to think about was where can we access kids who are at risk and then how can we provide support for the practices who are going to be seeing these kids more and more?”

Six years ago, Dr. Anthony and his team began training local providers at family medicine and primary care practices in the National Institute of Mental Health’s Facilitated Suicide Prevention Pathway to address this very need. So far, his team has worked with 12 practices and trained approximately 300 providers. 

That is no easy task, considering the amount of effort that goes into the training and the challenges that these providers face. The team starts with an initial consultation meeting, before scheduling two sessions that walk providers through the five steps of the prevention pathway. Trainers cover everything from how to screen patients for suicide risk and talking to families about prevention, to assessing risk and developing safety plans. After the training sessions are over, the work continues. Dr. Anthony’s team remains connected to primary care sites for a full year, addressing barriers to implementation, answering questions and meeting monthly. 

This practice facilitation approach has proven effective anecdotally, allowing Dr. Anthony and his partners to ensure providers feel comfortable providing mental health care (something few are technically trained in), have the time to address patient needs and are confident in the protocol. 

To truly demonstrate the impact of this work, Dr. Anthony and his colleagues Brian Pitts, MD, and Christina Studts, PhD, MSPH, LCSW, are undertaking a new study funded by the National Institute of Mental Health. Over the next three years, they will enroll new practices in the program, randomly assigning half to training alone and half to ongoing practice facilitation. His team will seek to understand whether the additional facilitation leads to improved implementation measures and better patient outcomes.

“Does the large amount of effort that we're putting in, sticking with the practices for a long time afterwards, meeting with them, helping them with various components of the protocol — is that actually making a difference in outcomes?” Dr. Anthony asks. “That's what we're testing with this grant.”

Dr. Anthony expects to find significantly better patient outcomes with ongoing facilitation. In the meantime, from follow-up evaluations, the team has noted that providing this training has made a world of difference for those primary care doctors, family doctors and nurses on the frontlines of the mental health crisis. 

“We've become real colleagues,” he says. “What's really very rewarding for our team is when you get feedback from practices saying, ‘I just want to tell you that we met with this family. Suicide was a concern, but I knew what to do. I knew how to make a safety plan. I knew how to follow up with this, and it has been such an important thing for me.’”