New AMA Policy Calls for Physician Training on Suicide

Megan Brooks

June 22, 2018

To combat the growing suicide epidemic in this country, the American Medical Association (AMA) adopted a new policy to increase awareness and physician training on suicide.

Suicide rates in the United States have risen nearly 30% since 1999, according to recently released data from the Centers for Disease Control and Prevention (CDC).

The new policy, expressed in resolution 312, was adopted this month at the AMA 2018 Annual Meeting in Chicago. It states that the AMA will "engage with the appropriate organizations to facilitate the development of educational resources and training related to suicide risk of patients, medical students, residents/fellows, practicing physicians, and other health care professionals, using an evidence-based multidisciplinary approach."

"With an increasing number of people committing suicide in the US, we must do everything we can to help increase awareness about the risk factors for suicide," AMA President Barbara L. McAneny, MD, said in a statement.

"By educating patients, students, residents, practicing physicians and other health care professionals on the risks associated with suicide, we will all be better equipped to identify patients, colleagues, friends, and others who are at risk of suicide and help save lives," said McAneny.

We need all hands on deck to stem the epidemic. Dr Maria Oquendo

Reached for comment on the new policy, Maria A. Oquendo, MD, PhD, past president of the American Psychiatric Association (APA) and chair of psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, said it's "very timely that suicide become more of a focus in the house of medicine. As the suicide rate continues to climb, we need all hands on deck to stem the epidemic. Data show that a substantial proportion of individuals who die by suicide have seen a physician in the prior 90 days. That is a missed opportunity to save lives."

Oquendo noted that use of screening tools such as the Patient Health Questionnaire–9, which patients can complete on tablets while in the waiting room, can help physicians identify individuals struggling with suicidal ideation or behavior.

"Busy practitioners are often wary of assessing these symptoms because they are not sure what to do about them in the moment. Having well-established protocols for risk stratification and appropriate referral or other action can provide critical support to the clinician," said Oquendo.

"Suicide is preventable," she added. "Treating the accompanying psychiatric condition can be lifesaving. Today, there are several specific, evidence-based interventions for suicidal individuals, like Cognitive Therapy for Suicide and Safety Planning. Disseminating interventions like these would be of great utility."

Call to Action on Guns

At its annual meeting, the AMA also amended its existing policy on firearm safety and research to recognize the role of gun-related suicides.

According to the CDC, suicides by firearm make up nearly 60% of all firearm deaths in the United States each year. Suicide is a leading cause of preventable death in the United States, and firearms are among the most lethal methods for attempting suicide; nearly 9 of 10 attempts result in death.

The amended AMA policy encourages the development of curricula and training for physicians that focus on suicide risk assessment and prevention, as well as lethal means safety counseling. It also encourages physicians, as a part of their suicide prevention strategy, to discuss gun safety and to work with families to reduce access to lethal means of suicide.

"While the need for firearm injury prevention among high-risk individuals is widely accepted as an effective clinical intervention, too few physicians are actually conducting screening and counseling to increase safety, especially when it comes to suicide," McAneny.

"We need more physicians to counsel their patients who are at high risk for violence and suicide and work with their families to learn as much as possible about their access to firearms and other lethal means. Doing so may help prevent suicides and help keep families from enduring the tragic loss of a loved one," said McAneny.

The AMA House of Delegates also passed a number of resolutions to bolster existing policies on gun safety and violence prevention. The resolutions include a call for gun violence restraining orders that would provide a mechanism to remove firearms from individuals at increased risk for violence to themselves or others.

Delegates also agreed that teachers should not be armed and that the sale and ownership of all assault-style weapons should be banned, as reported by Medscape Medical News.

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