Suicide is a societal epidemic and a staggering public health crisis. In 2021, someone died by suicide every 11 minutes in the United States, according to the Centers for Disease Control and Prevention. That rate equates to nearly 50,000 Americans every year. An additional 1.7 million people attempted suicide in 2021, and over 12 million more reported having suicidal thoughts.
Yet most medical schools do not adequately address the topic of suicide, leaving new physicians poorly equipped to identify and assess suicidal patients and refer them for treatment.
But there is a growing movement toward addressing mental health issues in medical schools, including at Florida International University, where the three of us are associate professors of psychiatry and behavioral health. Our program prioritizes training a new crop of physicians who will be prepared and motivated to discuss suicide with their patients. Changes can be as simple as teaching medical students to be nonjudgmental and removing the stigma around the topic.
When a person takes their own life, the phrase “committed suicide” is often used, as if it were a sin or a crime. This is partly because historically, most religions have considered suicide to be sinful, and as a result, it is treated as taboo.
The verb “commit” in the context of suicide can suggest a criminal act. In contrast, using language such as “died by suicide” or “took their own life” is less stigmatizing and more neutral, which is why these phrases are recommended by advocates of mental health as best practices.
Because of the stigma surrounding suicide, medical schools do not equip up-and-coming doctors with the language, comfort and skills needed to recognize it and properly address it with their patients.
The first point of contact for patients seeking treatment for mental health conditions is usually their primary care physician. About 44 percent of those who died by suicide worldwide had visited their primary care provider within one month of their death.
Why do so many Americans take their lives shortly after seeing a primary care provider?
There’s a combination of factors, including the continued stigma of mental health problems, limited access to mental health professionals and the fact that primary care providers wind up being the first point of contact with the patient. A 2023 study found that approximately one-third of patients received mental health care from their primary care provider.
Many of these doctors don’t pick up on the signs of suicidal ideation. It’s also possible the doctors simply don’t have the necessary time to spend with the patients, even when intervention is needed. Many physicians who are not psychiatrists are also unprepared or uncomfortable discussing suicide and not trained on asking vitally important questions about suicide.
At Florida International University, where we are associate professors of psychiatry and behavioral health, we train all medical students, beginning in the first year, on how to discuss suicide with patients. This helps to normalize the topic as just another part of their medical training, which, in turn, destigmatizes it.
We then emphasize the need for comfort and familiarity with the topic, as well as the many myths surrounding it. For example, there’s a false belief that asking a patient about suicide will increase the likelihood they will act upon the suicide. Research indicates otherwise.
Finally, students are told that doctors must create a safe environment for their patients to be open about discussing sensitive topics. In short, doctors must ask questions about suicide in a way that’s not pejorative or dismissive. They must not apologize to the patient or shy away from the subject.
Statements like “I’m sorry to have to bring this up” or “I’m sorry if this question seems too personal” can be an indication of discomfort or uneasiness. Instead, doctors should ask direct and specific questions like, “Have you had any thoughts about ending your life?” or “Are you having any thoughts of suicide?”
After a risk assessment is completed, a patient would be hospitalized if they are at risk — there is no mandate for doctors to report on or act on depression.
Although universal suicide screening practices have yet to be made best practices nationally, there are many reasons a standard screening process would be beneficial. Training in suicide assessment and prevention can be made mandatory for medical license renewal, which would include universal screening practices.
For example, adopting best practices could include offering suicide screening during routine health-care visits to identify people at risk who might not otherwise be identified.
Another example: More than half of 15,000 children and adolescents who were seen in a pediatric hospital emergency room for non-psychiatric reasons between March 18, 2013, and Dec. 31, 2018, were also experiencing suicidal ideation and behaviors. These examples emphasize the critical need to train doctors in suicide assessment and prevention. Currently, there are only nine states that require any training on suicide assessment and prevention for doctors to renew their medical licenses.
In addition, doctors can use empathy, compassion and a nonjudgmental approach, rather than making the patient feel like they are being cross-examined by a lawyer. Interacting empathically leaves the patient feeling more understood and comfortable disclosing sensitive information.
If you or someone you know is considering suicide, please call or text 988 for confidential, free support.
Rodolfo Bonnin is an assistant dean for institutional knowledge management at Florida International University. Leonard M. Gralnik is chief of education and senior medical director at Florida International University, and Nathaly Shoua-Desmarais is an assistant dean for student success and well-being. All three are associate professors of psychiatry and behavioral health at the school.
This article was produced in collaboration with theconversation.com.
