Application of the Zero Suicide Model in Residency Training

Abstract

The increasing suicide rate in the USA is a national crisis. In 2016, nearly 45,000 people in the USA died by suicide, which represents a > 30% increase between 2000 and 2016 [1]. Further, for every reported suicide, an estimated 25 suicide attempts occur. Suicide is the tenth leading cause of death in the USA, and psychiatrists are often on the frontlines of suicide prevention. Psychiatrists staff emergency departments (EDs) and serve on consultation-liaison services in general hospitals, evaluating suicide risk. In clinic settings, psychiatrists may function in clinical oversight roles for other mental health clinicians and be called upon to evaluate at-risk patients. Psychiatrists on inpatient units serve as primary providers and oversee discharge of at-risk patients. Additionally, with increased collaborative care models, psychiatrists play an increasingly important role in primary care settings [2]. To that end, it is critical that psychiatrists have the skills, knowledge, and clinical familiarity needed for suicide prevention. In 2016, the Joint Commission ushered in what is hoped to become a new focus on suicide prevention, with the Sentinel Event Alert, which aims to “assist all health care organizations providing both inpatient and outpatient care to better identify and treat individuals with suicidal ideation” ([3], p. 1). There is increasing recognition of the need to train the next generation of medical professionals, including psychiatrists, in suicide prevention. Concerted efforts to teach evidence-based approaches to suicide prevention in residency can provide guidance for more effective interventions. Psychiatrists and psychiatric residents should feel competent, if not comfortable, in identifying, assessing, and managing patients presenting with suicidal ideation at all levels of acuity and psychopathology. We suggest that adopting the Zero Suicide model of suicide prevention [4] in residency training may be helpful by providing an organized and integrated approach to working with suicidal patients. It is one approach to improving teaching in suicide prevention, and it has the potential to provide a comprehensive framework and to help consolidate residents’ knowledge, skills, and attitudes about suicide prevention.