Clinical Support Program for Adult Suicide Risk in Primary Care

This program addresses a critical need for adults who are at risk for suicide. It helps to improve their care and outcomes in primary care settings. It focuses on how to identify people who are at risk, evidence-based interventions and standards of care, research on outcomes, and much more.

Program Overview

This clinical program focuses on adults age 18+ who experience chronic or intermittent suicidal ideation. It offers an array of effective resources and training for primary care providers. This helps them support adults who are at risk. Topics include how to identify adults who are at risk; guidance for next steps in care; how to integrate behavioral health into primary care settings; strategies to prevent suicidal crises and improve patient outcomes; and more. One important goal of the program is to to help improve quality of life for at-risk adults. Another goal is to enhance the confidence that providers have to support the at-risk adults that they see in their practices.

Preliminary results from the program show lower symptoms of depression, anxiety, and suicide risk based on testing and interviews.

Patients were tracked over three months to determine how many went to the hospital or emergency department due to continued suicidal thoughts or psychiatric concerns.

Program Impact

Primary care providers are critical gatekeepers. They can help identify and manage suicidal risk. An estimated 45% of people who make a suicide attempt were seen in primary care in the month prior. In fact, more prescriptions for antidepressant medications are written in primary care. This creates a unique opportunity to intervene with at-risk individuals before an acute crisis. However, primary care providers need more interventions to treat suicide risk adequately. Coping with Long Term Active Suicide in Primary Care (CLASP-PC) is an interdisciplinary collaboration between the Suicide Prevention Institute and the UNC Eastowne Internal Medicine Clinic. CLASP-PC is an evidence-based, manualized approach that can be used for treatment intervention and risk reduction. It expands the boundaries of integrated care models and increases accessibility to suicide-focused treatment for patients with chronic or episodic suicidal risk.

The program is embedded clinically at UNC Hospitals Outpatient Center at Eastowne
The project team provides education and workshops to a variety of groups across North Carolina such as Area Health Education Center (AHEC), UNC Veterans Resource Center, UNC Counseling and Psychological Services, Pinnacle Family Services of Raleigh, and social work graduate programs.
The program uses multiple training modalities that include CLASP (Coping with Long Term Active Suicide Program), CALM (Counseling on Access to Lethal Means), Stanley Brown safety planning, the Valued Living Questionnaire, and Life Plan I and II
Success for this program means primary care providers foster a collaborative and supportive environment where individuals feel empowered to seek help - and providers themselves feel equipped to guide them effectively.

"A man in his 20’s struggling with suicidal thoughts was identified by his primary care provider and referred to CLASP-PC. During the intake session he disclosed thoughts of using a gun to kill himself. He had access to two unsecured firearms in his family home and his family was unaware of his distress and his suicidal risk. We collaborated with his support person to create a safety plan that prepared him to talk to his family and ask for the guns to be removed. We rehearsed the conversation until he felt prepared to say the words that could save his life. The family removed the guns that day and because he was able to share what he had been going through, they were able to support him in the steps he was taking to get well."

Manuscript in Development

CLASP-PC: A Rapid Response to Suicidality in Primary Care: Adaptation of hospital-based CLASP to a multi-modal intervention for chronic and intermittent episodes of suicidality for patients seen in outpatient primary care