November 20, 2018
The Bottom Line: Some Texas physicians are trying to help prevent suicides with mental health screening and identifying patients’ suicidal thoughts during a routine examination. Data shows most victims visit a doctor shortly before taking his or her life.
The aftermath of a suicide can leave a grieving family with shock and questions that will not go away. It is especially devastating to a physician if the loved one is a family member. A day after law enforcement released Landon Powell from the Bexar County Adult Detention Center in November 2016, he hanged himself. His father Dan Powell, MD, a long-time San Antonio family physician, says his son’s death changed his attitude on screening patients’ behavioral health for suicidal thoughts. He has core questions.
“What does someone have to keep them going?" Dr. Powell said. "What do they have to get up out of bed in the morning for? What gives them meaning or purpose? And I think in my practice and certainly in my life, that's what I've focused more on — do my patients have no hope? … That relates to my son's case. He was running out of purpose, reason."
Suicide is a growing problem in the United States. The warning signs are not always apparent, but primary care physicians might be able to help prevent these deaths. Nearly half (45 percent) of people who die by suicide have contact with a physician or primary care provider in the month before, according to a 2002 American Journal of Psychiatry study. "Half of people are going to their doctors in the month before their deaths … so there's a real opportunity there for the docs to reach them," said Jenna Heise, the statewide suicide prevention coordinator at the Texas Health and Human Services Commission, in Texas Medical Association’s (TMA’s) Texas Medicine magazine.
"Physicians need to recognize that they're the frontline person that people go to most often, and they're in a position to be most effective," said Stacey Freedenthal, PhD, a licensed psychotherapist who specializes in suicide risk and mental health assessment. "Not only can many people not go to a mental health specialist because of finances or whatever, there are many who choose not to because of the stigma."
Many people have easier access to primary care physicians than to behavioral health specialists, particularly in some rural areas. And many physicians use screening tools to help identify people thinking of suicide. However, the social stigma around suicide can dissuade even some physicians, health care workers, as well as patients and their family members, from addressing the topic.
Primary care physicians can help remove the stigma by encouraging conversations about depression and suicide with their patients, says Leslie Secrest, MD, chair of the TMA Task Force on Behavioral Health. "[Primary care physicians] may not have all the answers," said Dr. Secrest, a professor of psychiatry at The University of Texas Southwestern Medical Center in Dallas. "But [their offices] are a venue in which answers can be found."
The recent suicide deaths of celebrities like chef Anthony Bourdain and fashion designer Kate Spade shocked and saddened fans. They highlighted statistics the Centers for Disease Control and Prevention (CDC) released in June showing that between 1999 and 2016, suicide rates rose nearly 30 percent nationwide. In Texas, the rate of suicide is not as high, but in 2015, it was the 12th leading cause of death, according to the Texas Department of State Health Services. However, among certain age groups, suicide rates are quite high. Suicide was the second leading cause of death for 15- to 34-year-old Texans after accidents, which mirrors CDC national statistics.
Mental illness played a role in young Mr. Powell’s death, as happens with about 46 percent of all suicides. In 2017, the Texas Legislature enacted a series of reforms designed to improve mental health care in Texas, by giving people greater access to doctors’ care. The legislature expanded Medicaid for post-partum depression screenings and annual adolescent mental health screenings. The legislature also expanded access to telemedicine, allowing physicians to care for patients outside of the traditional office visit.
Dr. Powell hopes his family’s tragedy will help change physician attitudes about mental health screening and identify more people contemplating suicide.
"I still keep family photos in the exam room," Dr. Powell said. "They're a good lead-in for being able to talk about mental health and how it's affected our family and how we lost our son. I think that opens up communication, number one. And if they're comfortable talking to you, they're going to be more likely to talk to you. I think for me that's something that's opened some doors.”
TMA is the largest state medical society in the nation, representing more than 51,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
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