Fifty years of research indicates that no currently identifiable risk factors actually predict death by suicide (see Franklin et al., 2017). Add to this: Neither suicide prevention strategies (Zalsman et al., 2017), nor primary care screening have been shown to decrease deaths by suicide (Milner et al., 2017).
Why, then, do we spend so much effort screening or assessing for suicide risk in our mental health service intake procedures? For that matter, why do we spend so much time on any type of assessment at intake when transdiagnostic approaches have been shown to be helpful for virtually all conditions? Even David Barlow, the once-king of training manuals for just about every DSM diagnosis, has changed his tune – advocating now for his unified protocol (Barlow & Farchione, 2018).
In Newfoundland and Labrador (NL), we are shifting beyond the “risk paradigm” that has unjustifiably restricted access to care through unnecessary assessment-heavy protocols that delay treatment and curb innovation. Care, unencumbered by screening questions, is available immediately through three modalities: a web portal called bridge the gApp, telephone and text care through both crisis and support lines, and walk-in counselling across the Province through the Doorways program (click below image for details on NL programming).
Care for All
Care is offered to all, not just those in crisis or with severe symptoms. This acknowledges the power and potential for meeting needs upstream whenever people are ready to do something about their mental health. Surely this is the best suicide prevention.
With Stepped Care 2.0, natural community supports – both formal and informal – are key components of the health system (see the CMHA’s version of stepped care below). Professionals endorse these when indicated through continuous objective outcome monitoring.
Click here for CMHA source document.
Barlow, D. H., & Farchione, T. J. (2018). Applications of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. New York: Oxford.
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., . . . Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143, 187–232.
Milner, A., Witt, K., Pirkis, J., Hetrick, S., Robinson, J., Currier, D., Spittal, M. J., Page, A., & Carter, G. L. (2017). The effectiveness of suicide prevention delivered by GPs: A systematic review and meta-analysis. Journal of Affective Disorders, 210, 294-302.
Zalsman, G., Hawton, K., Wasserman, D., van Heeringen, K., Arensman, E., Sarchiapone, M., … & Purebl, G. (2016). Suicide prevention strategies revisited: 10-year systematic review. The Lancet Psychiatry, 3(7), 646-659.