Five opportunities for health administrators to change the narrative around suicide stigma

2. Suicide stigma makes mental health conversations difficult—but understanding cultural and individual differences is a strong start

Stigma around suicide is one of the greatest impediments to mental health conversations.

Because of the stigma around suicide and mental disorders, many patients don’t seek help or are not open with their providers about thoughts of taking their own life. This complicates provider responsibility in navigating sensitive conversations—suicide risk varies across culture, geography, and sex/gender.

Many cultural belief systems consider suicide a sin. Geographically, in areas where thoughts of suicide are stigmatized, many survivors will hide the fact that they had a close relative commit suicide. A 2019 study on the stigma of suicide suggests that national variations in suicide rates can reflect cultural beliefs about mental illness and stigma. In the realm of gender, a National Center for Transgender Equality (NTCE) survey found that 28% of respondents postponed medical care because of discrimination. They also faced serious hurdles to access, including refusal of care and a lack of provider knowledge.

This is a two-sided challenge and provider interactions themselves can be a barrier to care. Many provider organizations lack awareness of suicide as a significant and global public health concern.

Healthcare administrators need to understand their national suicide prevention landscape, regional risks, and attitudes within their own organizations to help providers in understanding patient hesitancies. They should focus on training on empathy and cultural competence and tools that help with supporting diverse patient populations.

3. Some governments aren’t supporting their people in suicide prevention—but healthcare providers are an untapped opportunity

Many countries and regions lack robust mental health support—a factor that can complicate provider mental health conversations. In the US, mental health services tend to fall short of community needs, even as over half the population has sought help.

Only 38 countries have reported maintaining a national suicide prevention strategy according to the WHO. Some resources are still available—the United States maintains the Suicide and Crisis Lifeline, available in English or Spanish by dialing 988, and many other countries maintain emergency support through a 999 number or local suicide hotlines. In this environment, providers are key sources of patient support in navigating social determinants of mental health such as having lower levels of education, leaving school at a younger age, or having fewer years of formal education.

Since physicians can be held responsible for patient suicides or even criminally liable in some countries, healthcare administrators can realize significant benefits and risk mitigation by equipping their providers to have effective mental health conversations.

4. Comprehensive suicide prevention is rare—and PCPs are a critical point of support

Primary care will be a central point of access in improving mental health conversations and suicide prevention outcomes.

The Suicide Prevention Resource Center reports that, out of all healthcare providers, people who die by suicide are most likely to have seen a PCP in the month before their death. The Center recommends a few components as a part of a comprehensive approach to suicide prevention:

• protocols for screening, intervention, assessment, and referral
• training for staff in suicide care protocols and practices, including lethal means counseling
• referral agreements with behavioral health practices that take referrals
• ensuring continuity of care through seamless care transitions

As mental health issues increase in prevalence, healthcare administrators should integrate mental health support into primary care. Clinicians need evidence-based decision support tools as they research topics on self-harm, mental health, suicide prevention, and cultural stigmas.

5. Clinicians often suffer unnoticed—and administrators can make a change

Productive mental health conversations with patients require healthy staff. Nurses and healthcare support workers have higher rates of suicide. Physicians face higher levels of suicide risk and suicidal ideation. These issues are associated with medical errors and high workload volume and are separate and distinct from burnout and depression. Physicians having suicidal ideation are less likely to seek help.

Healthcare administrators should move proactively to counter physician distress and create a supportive workplace that includes confidential resources that are updated regularly and are based on recent clinical evidence.

Healthcare administrators can be proactive in suicide prevention

Provider leadership has growing opportunities to implement effective mental health support and suicide prevention strategies in clinical settings. In their mental health conversations, clinicians are actively searching terms like self-harm, suicide, and specific mental health disorders. They’re working to make connections for their patients, change modifiable risk factors, and respond to non-modifiable issues.

As more of the world acknowledges the importance of suicide prevention, healthcare administrators should look for productive opportunities to address suicide and self-harm in their care communities.

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