Suicide Prevention Part II: It'll take a coordinated effort

Suicide is a serious problem in San Juan County and much more needs to be done to  prevent it. Little has been done by the county's Public Health Department, but Peace Island Medical Center and San Juan Island EMS on San Juan Island are developing programs that will help.

San Juan Island EMS is developing a Community Paramedicine program. According to SJI EMS websiteSuch home visits are part of a new statewide Community Paramedicine program that became law in 2015. The legislation allows paramedics and EMTs to enter private homes to provide non-emergency health services. The goal is to allow people with chronic conditions to continue to live independently, and reduce the number of hospital visits through home health visits and preventive programs. This is especially beneficial in a rural community, where EMS personnel can collaborate with local doctors to be another set of eyes and ears in people’s homes.

PeaceHealth Peace Island Medical Center in Friday Harbor is working with Qualis Health which is serving as the State of WA Practice Transformation Support Hub to create a model site integrating Primary Care and Behavioral Health. A video showing how such a program works in Yakima, can by viewed at the bottom of this page.  

In a previous article,  PIMC's Behavioral Health Consultant Gary Waters PhD work at the medical center was covered. All patients are screened by their primary care providers for Behavioral Health concerns during appointments. If there is a concern, Waters can come into the exam room and meet with the patient. 

Statistics show that if just given a piece of paper with a referral, 75 percent of patients don't follow through. The Unify Clinic in Spokane describes their set up as "behavioral health consultants are members of the primary care team, using warm handoffs and face-to-face communication to share information about their patients’ progress."


According to a study by Luoma JB, Martin CE, Pearson JL "Contact with mental health and primary care providers before suicide: a review of the evidence": Contact with primary care providers in the time leading up to suicide is common. While three of four suicide victims had contact with primary care providers within the year of suicide, approximately one-third of the suicide victims had contact with mental health services. About one in five suicide victims had contact with mental health services within a month before their suicide. On average, 45% of suicide victims had contact with primary care providers within 1 month of suicide. Older adults had higher rates of contact with primary care providers within 1 month of suicide than younger adults. 

The Substance Abuse and Mental Health Service Administration website lists the warning signs doctors need to look for: 

Talk of wanting to hurt or kill oneself

Unusual contemplation of death, dying, or suicide

Feelings of being trapped—like there’s no way out

Feelings of hopelessness or that there is no purpose in life

Withdrawal from friends, family, and society

People at risk of suicide may also present with:

Increased alcohol or substance use


Rage/uncontrolled anger

Trouble sleeping or sleeping all the time

Dramatic mood changes, including sudden elevation in mood

The Columbia Suicide Severity Rating Scale  can be administered by physicians, nurses, psychologists, social workers, peer counselors, coordinators, research assistants, high school students, teachers and clergy.

Regarding suicide prevention, the county Health and Community Services Department has a long way to go. Several years ago there were four suicides in two weeks.  I asked the county's Health Officer Dr. Frank James for a comment for an article I was writing about suicide prevention. He said the best thing to do is to not talk about it. 

Currently San Juan County's Behavioral Health Organization (BHO) is North Sound Mental Health Administration. The county contracts with Compass Health to provide mental health and substance abuse services to Medicaid patients.

The state has ordered integration of Behavioral Health and Physical Health services by 2020.

In what has to be one of the most convoluted discussions, county Health and Community Services staff talked with the county Council about the state's directive and the 2020 deadline. The discussion can be viewed at the 3:31 mark on the video of the August 15, 2017 council meeting

After watching the video, it is glaringly obvious that the county council and H&CS staff need to become aware of programs that are already available or in development in the county. Working together with all the medical providers in the islands, the county would stand a better chance of creating an efficient, cost-effective  system that would reduce the number of islanders who end up dealing with the heartbreaking consequences of death by suicide. 

The National Suicide Prevention Line  1.800.273.8255




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