Suicide prevention in primary care

Several years ago, a college student asked me for feedback about an essay she’d written. I usually enjoy helping young writers, but this
request made me very uncomfortable. In the essay, the student detailed her long struggle with depression, including several hospitalizations and suicide attempts. She mentioned in the last paragraph that sometimes she still wished she were dead.

When we met for coffee to discuss her work, I told the student that as a doctor — not to mention the mother of a daughter her age — I could not comment on the literary merits of her essay without expressing concern about its content. Was she under a psychiatrist’s care? Did she feel safe? Did she have a support network to whom she could turn if she felt suicidal again?

The answer to all these questions was yes. She acknowledged that she still had dark thoughts now and then, but assured me that she would not harm herself. She was taking medication and seeing a therapist frequently. She had close relationships with her parents and with many friends in whom she could confide. We kept in touch for a few months afterward and, indeed, she seemed to be thriving.

Earlier this month, the World Health Organization released its first report on suicide prevention. The report noted that suicide is a global crisis, causing 800,000 deaths per year worldwide. Though poverty, social isolation, and limited access to mental health care are all risk factors, neither wealth, popularity, nor psychiatric treatment make someone immune, as the recent suicide of comedian Robin Williams sadly highlighted.

The WHO report set a goal of reducing suicide rates 10 percent by 2020 and mentioned several steps that might be taken to do so, including limiting the availability of firearms, avoiding sensationalized media coverage of suicides, and increasing efforts to identify and treat people whose mental illness and substance abuse place them at high risk of self-harm.