Team-based suicide prevention: lessons learned from early adopters of collaborative care

ABSTRACT

Suicide prevention in clinical settings requires coordination among multiple clinicians with expertise in different disciplines. We aimed to understand the benefits and challenges of a team approach to suicide prevention in primary care, with a particular focus on Veterans. The Veterans Health Administration has both a vested interest in preventing suicide and it has rapidly and systematically adopted team-based approaches for primary care interventions, including suicide prevention. We conducted eight focus groups and eight in-depth interviews with primary care providers (PCPs), behavioral health providers and nurses located in six regions within one Veterans Administration Catchment Area in the northeast of the US. Transcripts were analyzed using simultaneous deductive and inductive content analysis. Findings revealed that different clinicians were thought to have particular expertise and roles. Nurses were recognized as being well positioned to identify subtle changes in patient behavior that could put patients at risk for suicide; behavioral health providers were recognized for their skill in suicide risk assessment; and PCPs were felt to be an integral conduit between needed services and treatment. Our findings suggest that clinician role-differentiation may be an important by-product of team-based suicide prevention efforts in VHA settings. We contextualize our findings within both a processual and relational interprofessional framework and discuss implications for the implementation of team-based suicide prevention.

KEYWORDS:

• Team-based care
• suicide prevention
• Collaborative care
• primary care

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention.

Notes on contributors

Marsha N. Wittink

Marsha N. Wittink, MD MBE is an Associate Professor of Psychiatry and Family Medicine and Director of the Medicine in Psychiatry unit at the University of Rochester Medical Center. Her research focuses on patient-centered interventions, decision-making and communication.

Brooke A. Levandowski

Brooke A. Levandowski, PhD, MPA is Assistant Professor in the Department of Obstetrics and Gynecology at University of Rochester Medical School. An epidemiologist, her research investigates how social determinants of health influence health decisions and stigmatized health outcomes, such as suicide.

Jennifer S. Funderburk

Jennifer S. Funderburk, PhD is a clinical psychologist at the VA Center for Integrated Healthcare. Her research to date has focused on the integration of behavioral health in primary care, with a special emphasis on the development of brief interventions.

Melanie Chelenza

Melanie Chelenza, MS worked as a Health Science Specialist at the Department of Veterans’ Affairs Center of Excellence for Suicide Prevention. Her research has focused on suicide prevention, PTSD and insomnia.

Jane R. Wood

Jane R. Wood, RN, ANP is an Adult Geriatric Nurse Practitioner at the Department of Veteran Affairs Outpatient Clinic in Rochester, New York. She specializes in the care of older adults with a focus on mental health issues and co-morbid conditions in the elderly population.

Wilfred R. Pigeon

Wilfred R. Pigeon, PhD is Executive Director of Department of Veterans Affairs’ Center of Excellence for Suicide Prevention and Professor of Psychiatry at the University of Rochester Medical Center where he is Director of the Sleep & Neurophysiology Research Laboratory.