The Role of Telehealth in Suicide Prevention: A Practice Framework for Primary Care
Main Article Content
Abstract
Globally, there are more than 700,000 suicide completions every year. With the continued shortage of mental health professionals, people are increasingly seeking care for mental health concerns in primary care settings. With the expansion of telehealth since the COVID-19 pandemic, more patients and providers are connecting virtually for appointments and are increasingly familiar with asynchronous tools to connect outside of appointments. Practitioners in primary care settings have an important role in identifying and mitigating risk of suicide regardless of the treatment modality. Utilization of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model for suicidal patients is both necessary and feasible in the current hybrid healthcare environment. This manuscript addresses the practical and procedural considerations for assessing for suicide and developing effective safety planning interventions when using telehealth as part of care.
Keywords:
Safety planning, suicide, telehealth, direct to person, hub and spoke, primary care
Article Details
How to Cite
SOPCHAK, Kelly; MCCORD, Carly E..
The Role of Telehealth in Suicide Prevention: A Practice Framework for Primary Care.
Medical Research Archives, [S.l.], v. 12, n. 11, nov. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6037>. Date accessed: 12 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i11.6037.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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31. Olfson M, Weissman MM, Leon AC, et al. Suicidal ideation in primary care. J Gen Intern Med. 1996;11(8):447-453. doi:10.1007/BF02599038
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34. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606.x
35. Johnson JG, Harris ES, Spitzer RL, et al. The patient health questionnaire for adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients. J Adolesc Health. 2002;30(3):196-204. doi:10.1016/s1054-139x(01)00333-0
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37. Boudreaux ED, Brown GK, Stanley B, et al. Computer administered safety planning for individuals at risk for suicide: Development and usability testing. J Med Internet Res. 2017;19(5):e149. Published 2017 May 15. doi:10.2196/jmir.6816
38. Fremouw WJ, de Perczel M, Ellis TE. Psychology practitioner guidebooks. Suicide risk: Assessment and response guidelines. Pergamon Press; 1990.
39. Stanley B, Brown GK. The safety plan treatment manual to reduce suicide risk: Veteran version. United States Department of Veterans Affairs; 2008.
40. Candon M, Wolk CB, Kattan Khazanov G, et al. Treating individuals with suicidal ideation in primary care: Patient-level characteristics associated with follow-up in the Collaborative Care Model. Suicide and Life-Threatening Behavior. 2024;54(1):15-23. doi:10.1111/sltb.13012
41. Zubatsky, M, Edwards, TM, Wakabayashi, H, et al. Integrated behavioural health in primary care across the world: three countries, three perspectives, Family Practice, Volume 35, Issue 6, December 2018, Pages 645–648, https://doi.org/10.1093/fampra/cmy034
42. Lombardi BM, Zerden Ld, Krueger DK, et al. When interruption becomes innovation: How integrated behavioral health in primary care adapted during COVID-19. Fam Med. 2024;56(9):548-554. https://doi.org/10.22454/FamMed.2024.168465.
43. O'Grady C, Melia R, Bogue J, et al. A mobile health approach for improving outcomes in suicide prevention (SafePlan). J Med Internet Res. 2020;22(7):e17481. Published 2020 Jul 30. doi:10.2196/17481
2. Tarlow KR, Johnson TA, McCord CE. Rural status, suicide ideation, and telemental health: Risk Assessment in a Clinical Sample. The Journal of Rural Health. 2019;35(2):247-252. doi:10.1111/jrh.12310
3. Asarnow JR, Chung B. Editorial: COVID‐19: Lessons learned for suicide prevention. Journal of Child Psychology. 2021;62(8):919-921. doi:10.1111/jcpp.13489
4. Suicide. World Health Organization Accessed October 1, 2024. https://www.who.int/news-room/fact-sheets/detail/suicide
5. Mann JJ, Michel CA, Auerbach RP. Improving suicide prevention through evidence-based strategies: A systematic review. Am J Psychiatry. 2021;178(7): 611-624. doi:10.1176/appi.ajp.2020.20060864
6. Feldman MD, Franks P, Duberstein PR, et al. Let’s not talk about it: suicide inquiry in primary care. Ann Fam Med. 2007;5(5):412-418. doi:10.1370/afm.719
7. Luoma JB, Martin CE, Pearson JL : Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry 2002 ; 159 : 909 – 916
8. Graham RD, Rudd MD, Bryan CJ. Primary care providers’ views regarding assessing and treating suicidal patients. Suicide and Life-Threatening Behavior. 2011;41(6):614-623. doi:10.1111/j.1943-278X.2011.00058.x
9. Shoib S, Shaheen N, Anwar A, et al. The effectiveness of telehealth interventions in suicide prevention: A systematic review and meta-analysis. Int J Soc Psychiatry. 2024;70(3):415-423. doi:10.1177/00207640231206059
10. Atherton H, Brant H, Ziebland S, et al. Alternatives to the face-to-face consultation in general practice: Focused ethnographic case study. Br J Gen Pract. 2018;68(669):293300. doi: 10.3399/bjgp18X694853
11. Vodička S, Zelko E. Remote consultations in general practice – a systematic review. Zdr Varst. 2022;61(4):224-230. doi:10.2478/sjph-2022-0030
12. Ndwabe H, Basu A, Mohammed J. Post pandemic analysis on comprehensive utilization of telehealth and telemedicine. Clinical eHealth. 2024;7:5-14. doi:10.1016/j.ceh.2023.12.002
13. Agerwala SM, McCance-Katz EF. Integrating screening, brief intervention, and referral to treatment (SBIRT) into clinical practice settings: A brief review. J Psychoactive Drugs. 2012;44(4):307-317.
14. Carmel A, Ries R, West II, et al. Suicide risk and associated demographic and clinical correlates among primary care patients with recent drug use. Am J Drug Alcohol Abuse. 2016;42(3):351-357. doi:10.3109/00952990.2015.1133634
15. Doupnik SK, Rudd B, Schmutte T, et al. Association of suicide prevention interventions with Subsequent suicide attempts, linkage to follow-up care, and depression symptoms for acute care settings: A systematic review and meta-analysis. JAMA Psychiatry. 2020;77(10):1021-1030. doi:10.1001/jamapsychiatry.2020.1586
16. Haste F, Charlton J, Jenkins R. Potential for suicide prevention in primary care? An analysis of factors associated with suicide. Br J Gen Pract. 1998;48(436):1759-1763.
17. Berkelmans, G., van der Mei, R., Bhulai, S. et al. Identifying socio-demographic risk factors for suicide using data on an individual level. BMC Public Health 21, 1702 (2021). https://doi.org/10.1186/s12889-021-11743-3
18. Martinengo L, Van Galen L, Lum E, et al. Suicide prevention and depression apps’ suicide risk assessment and management: A systematic assessment of adherence to clinical guidelines. BMC Medicine. 2019;17(1):231. doi:10.1186/s12916-019-1461-z
19. Forte A, Sarli G, Polidori L, et al. The role of new technologies to prevent suicide in adolescence: A systematic review of the literature. Medicina. 2021;57(2):109. doi:10.3390/medicina57020109
20. Shain B, Braverman PK. Suicide and suicide attempts in adolescents. Pediatrics. 2016;138(1):e20161420. doi:10.1542/peds.2016-1420
21. McManama O’Brien KH, Almeida J, et al. A safety and coping planning intervention for suicidal adolescents in acute psychiatric care. Cognitive and Behavioral Practice. 2021;28(1):22-39. doi:10.1016/j.cbpra.2019.08.003
22. Global diffusion of eHealth: Making universal health coverage achievable. Report of the third global survey on eHealth. Geneva: World Health Organization; 2016. Licence: CC BY-NC-SA 3.0 IGO.
23. Telehealth basics. American Telemedicine Association. Accessed October 2, 2024. https://www.americanantelemed.org/resources/why-telemedicine/
24. Stanley B, Brown GK. Safety Planning Intervention: A brief intervention to mitigate suicide risk. Cogn Behav Pract. 2012;19(2):256-264. doi:10.1016/j.cbpra.2011.01.001
25. Joint Task Force for the Development of Telepsychology Guidelines for Psychologists. Guidelines for the practice of telepsychology. Am Psychol. 2013;68(9):791-800. doi:10.1037/a0035001
26. Americal Psychological Association (2024). Proposed Revision of Guidelines for the Practice of Telepsychology. Retrieved from https://www.apa.org/practice/guidelines/telepsychology-revisions.pdf
27. Ponciano C, Philip J, Tarlow KR, et al. Self-reported client concerns in telehealth counseling services with minority groups. Poster presented at: APA Division 45: Society for the Psychological Study of Culture, Ethnicity and Race Annual Conference; 2018.
28. McCord CE, Rosner C, Walsh MVV, et al. A cube model for competency development in telepsychology. J Clin Psychol. 2020;76(6):1060-1082. doi:10.1002/jclp.22954
29. McCord CE, Console K, Jackson K, et al. Telepsychology training in a public health crisis: A case example. Couns Psychol Q. 2020. doi:10.1080/09515070.2020.1782842
30. Brown GK, Wolk CB, Green KL, et al. Safety planning intervention and follow-up: A telehealth service model for suicidal individuals in emergency department settings: Study design and protocol. Contemporary Clinical Trials. 2024;140:107492. doi:10.1016/j.cct.2024.107492
31. Olfson M, Weissman MM, Leon AC, et al. Suicidal ideation in primary care. J Gen Intern Med. 1996;11(8):447-453. doi:10.1007/BF02599038
32. Bjureberg J, Dahlin M, Carlborg A, et al. Columbia-suicide severity rating scale screen version: Initial screening for suicide risk in a psychiatric emergency department. Psychological Medicine. 2022;52(16):3904-3912. doi:10.1017/S0033291721000751
33. Posner K, Brown GK, Stanley B, et al. The columbia-suicide severity rating scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168(12):1266-1277. doi:10.1176/appi.ajp.2011.10111704
34. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606.x
35. Johnson JG, Harris ES, Spitzer RL, et al. The patient health questionnaire for adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients. J Adolesc Health. 2002;30(3):196-204. doi:10.1016/s1054-139x(01)00333-0
36. Culturally Competent Approaches, Suicide Prevention Resource Center. Accessed October 3, 2024. https://sprc.org/keys-to-success/culturally-competent-approaches/
37. Boudreaux ED, Brown GK, Stanley B, et al. Computer administered safety planning for individuals at risk for suicide: Development and usability testing. J Med Internet Res. 2017;19(5):e149. Published 2017 May 15. doi:10.2196/jmir.6816
38. Fremouw WJ, de Perczel M, Ellis TE. Psychology practitioner guidebooks. Suicide risk: Assessment and response guidelines. Pergamon Press; 1990.
39. Stanley B, Brown GK. The safety plan treatment manual to reduce suicide risk: Veteran version. United States Department of Veterans Affairs; 2008.
40. Candon M, Wolk CB, Kattan Khazanov G, et al. Treating individuals with suicidal ideation in primary care: Patient-level characteristics associated with follow-up in the Collaborative Care Model. Suicide and Life-Threatening Behavior. 2024;54(1):15-23. doi:10.1111/sltb.13012
41. Zubatsky, M, Edwards, TM, Wakabayashi, H, et al. Integrated behavioural health in primary care across the world: three countries, three perspectives, Family Practice, Volume 35, Issue 6, December 2018, Pages 645–648, https://doi.org/10.1093/fampra/cmy034
42. Lombardi BM, Zerden Ld, Krueger DK, et al. When interruption becomes innovation: How integrated behavioral health in primary care adapted during COVID-19. Fam Med. 2024;56(9):548-554. https://doi.org/10.22454/FamMed.2024.168465.
43. O'Grady C, Melia R, Bogue J, et al. A mobile health approach for improving outcomes in suicide prevention (SafePlan). J Med Internet Res. 2020;22(7):e17481. Published 2020 Jul 30. doi:10.2196/17481