Suicide Prevention Week is Sept. 10-16, but preventing suicide is something Central City Concern (CCC) thinks about every day of the year. “Zero Suicide” is the national model of treatment that CCC’s Old Town Clinic (OTC) has adopted and integrated into all aspects of the primary care it provides to more than 5,000 individuals it serves annually. It’s a commitment to the idea that every suicide can be prevented with the right kind of care.
“No matter what your position, we’re all responsible for suicide prevention,” says Brian Barnes, Associate Director for Behavioral Health in Primary Care at OTC. Barnes explains that making suicide prevention a system-wide priority and a routine part of care is the key to ensuring that no one falls through the cracks. Having clear, established procedures is better for patients and better for staff because it normalizes prevention and helps everyone know how to get the right kind of help.
At Old Town Clinic, this has meant incorporating questions about suicide into regular patient visits, establishing new protocols to ensure that clinicians are aware of patients who have a plan to harm themselves and designating a suicide "clinician of the day" who can respond to help, usually within five minutes. An intervention by the clinician of the day can last several hours—enough time to really engage someone in a moment of crisis, gain new perspective on a situation that may seem hopeless and come up with a concrete safety plan for the day, which clinic staff follow up on. Implementing these changes entailed a team-effort at the clinic, with leadership for designing and operationalizing the new procedures from Susan Marie, Senior Medical Consultant for Behavioral Health in Primary Care, and Lydia Bartholow, Associate Medical Director for Outpatient Substance Abuse Disorder Services.
“This type of work is more typical in a specialty mental health setting,” says Barbara Martin, Senior Director of Primary Care at CCC. But in serving some of Portland’s most vulnerable residents, OTC aims for a comprehensive approach. Many of the clinic’s patients face struggles that make primary care especially challenging: finding housing, getting and keeping regular access to health care, or dealing with addiction and other severe mental illness. At the same time, health care providers can lean on CCC’s extended network of wraparound services in housing, addiction treatment, employment services and social support.
“Suicide prevention starts way back,” Barnes says, “so that when we see a patient we are looking at the whole picture.” It requires going beyond crisis-intervention and stabilization to address long-term needs that support overall health and well being. Recalling how the clinic staff helped one person who recently attempted suicide, Barnes notes: “We were able to get her treatment here, at Old Town Clinic, change some things with her mental health medications, and get her housed in CCC housing with programming specifically designed for people recovering from addiction. We consider all of that primary care, because it’s primary to the person, to their overall care.”
Barnes and Martin both emphasize that everyone can help make zero suicide a reality. Go with your gut, they say, and reach out to a hotline or many of the other resources available if it seems that someone is at risk of harming themselves. “The most important thing is to listen,” Martin says, “because the evidence shows that if someone is getting close to a point of despair, thinking about hurting themselves, they often talk to people.” And Barnes adds: “Every person’s behavior can be explained if you understand the context, but if you don’t have time to understand the context, then get someone who can.”
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The Multnomah County Crisis Line is available 24/7: 503-988-4888.
The National Suicide Prevention Lifeline is also available 24/7: 1-800-273-8255
The David Romprey Oregon Warmline offers confidential peer support from 9:00 a.m. to 11:00 p.m. every day: 1-800-698-2392