The statistics are staggering. And they demand action. Over the past two decades, suicide mortality rates in the U.S. ranked second as the leading cause of death those 10-35 years of age,1,2 with the costs related to suicide totaling $70 billion.1,2 In 2017, Suicide claimed the lives of more than 47,000 people, ranking the tenth leading cause of death overall in the U.S.3
To help address suicide prevention, we must be aware of the behavioral health provider shortage. According to the U.S. Health Workforce Chartbook by the National Center for Health Workforce, in 2018 the behavioral health service providers included 217,449 psychologists, 377,763 Counselors, and 609,711 social workers.4 With over 3.8 million active RNs as of 2015,8 nurses represent the single largest group of health care providers and play a critical role in assessing all patients for warning signs of suicidal thoughts as they walk through the door. While all nurses have this responsibility, some have dedicated their studies to the practice, making big impacts in expanding mental health services and suicide prevention.
As the experts on the front lines of patient care, nurses have a wealth of knowledge that can be put to good use in creating policy and changing the status quo when it comes to mental health. A persuasive body of research evidence, indicates effective strategies to address mental health issues include four key ingredients:
Systematic outreach and diagnosis
Patient education and self-management support
Provider accountability for outcomes
Close follow-up and monitoring to prevent relapse.5
Nursing is a vital lifeline and asset to support these key evidence-based strategies, especially when implementing and monitoring practice guidelines. To illustrate the importance of elevating nurses via education to decision-making positions in this field, I would like to share the advice of Jonas nursing scholars who are actively making waves in mental healthcare in three areas: with veterans, marginalized populations, and nurses themselves:
Krista Roberts, Current DNP Scholar; University of Connecticut
Roberts’ work focuses on our country’s Veterans -- some of the most vulnerable people to mental illness and suicidal thoughts due to past experiences and service in the military. According to Roberts, “many providers aren't aware of the risk factors associated with suicide in veterans and many aren't even aware that they are treating a veteran.” She advises nurses to remain mindful of whether a patient has a military service history and how that patient’s time in the military may affect how they accept care.
“Veterans may be less likely to share information during mental health screenings because of the mental illness stigma in the military that has carried over into their civilian lives,” Roberts says. “Establishing a trusting relationship with a patient who is a veteran is one of the most important steps a nurse can take in order to provide quality care to veterans and encourage them to open up and be honest about symptoms they may be experiencing.”
Alasia Ledford, Current PhD Scholar; University of North Carolina-Chapel Hill
Ledford is working with American Indian and Alaskan Native women and children in preventing suicide in these particular, and often marginalized populations. She has seen firsthand how historical trauma of these communities is experienced and expressed inter-generationally. “Such things may not always be obvious when taking down the history of a presenting illness, which is why we as nurses need to take the time for suicide assessments,” Ledford says.
Because most marginalized evidenced-based research does not acknowledge these marginalized populations as statistically significant, their unique results and needs are often overlooked. “As health care practitioners, nurses cannot ignore the importance of understanding the disparities and inequities faced by this population, and how that impacts mental health,” says Ledford. Her counsel can be applied to any neglected or ignored community in the country.
Timothy Burns, Current PhD Scholar; St. Louis University
Mental health issues do not just affect patients but are issues that nurses, especially emergency room nurses, struggle with personally. Timothy Burns is working with emergency department nurses to create solutions to improve the care of the people who care for us. “Mental health issues – be it secondary traumatic stress, compassion fatigue, or burnout – were issues that my colleagues struggled with secondary to the provision of their jobs,” he says.
Burns encourages vigilance from healthcare staff in looking out for not only their patients but one another. “This vigilance is in each nurse looking out for their colleagues, understanding the signs and symptoms of compassion fatigue, secondary traumatic stress, and burnout, and intervening as appropriate. Succinctly, nurses need to have each other’s backs when it comes to personal mental health issues and suicide prevention.”
These three nurses, and all nurse leaders, in fact, play an important role in preparing the nursing workforce to better understand mental health and overcome the stigma or care avoidance for suicidal patients.1,5,7 Recognizing the critical role of health care in prevention suicide, the National Action Alliance for Suicide Prevention (Action Alliance) called for suicide prevention to become a “core component” of health care, and for improved professional and clinical practices.7 A comprehensive system-wide approach to suicide prevention, notably training, protocols, practice guidelines and quality assurance for fidelity are value-added strategies to adopt and sustain suicide prevention practice strategies.7 Thanks to nurses like Krista Roberts, Alasia Ledford, and Timothy Burns, I am hopeful for a future of leadership in facing this challenge head-on with compassion and creative solutions.
Brenes, F. (2019) Hispanics, Mental Health, and Suicide: Brief Report. Hispanic Health Care International, 17(3), 133-136. DOI: 10.1177/1540415319843-72
Stone, D. M., Simon, T.R, Fowler, K.A., Kegler, S.R. ….Crosby, A.E. (2018). Vital signs: Trends in state suicide rates-United States, 1999-2016 and circumstances contributing to suicide—27 states, 2015. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, 67, 617-624
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System https://www.cdc.gov/injury/wisqars/LeadingCauses.html (accessed September 19, 2019)
HRSA (Human Resources and Services Administration) 2018, National Center for Health Workforce Analysis. The U.S Health Workforce Chartbook. Part IV: Behavioral and Allied Health. https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/hrsa-us-health-workforce-chartbook-part-4-behavioral-and-allied-health.pdf (accessed September 18, 2019).
IOM (Institute of Medicine). 2012. The mental health and substance use workforce for older adults: In whose hands? Washington, DC: The National Academies Press
CDC (Center for Disease Control) Depression is Not a Normal Part of Growing Older | Healthy Aging | CDC https://www.cdc.gov/aging/mentalhealth/depression.htm (accessed September 19, 2019.
Grumet, J. G., Hogan, M. F., Chu, A., Covington, D. W., & Johnson, K. E. (2019). Compliance Standards Pave the Way for Reducing Suicide in Health Care Systems. Journal of Health Care Compliance—January–February, 17.
Journal of Nursing Regulation, The 2015 National Nursing Workforce Survey