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Tough legislative fight could be ahead for suicide prevention bill

Washington is already a leader in suicide prevention measures, but some health-care professionals don't want mandatory training extended to them.
Rep. Tina Orwall

Rep. Tina Orwall

Roughly 1,000 Washingtonians kill themselves every year, contributing to a suicide rate that is 15 percent above the national average. But if the state Senate passes and the governor signs a bill that passed the House 94-3 earlier this month, Washington will lead the nation in its efforts to prevent suicide. Granted, the bar has been set pretty low.

The bill now before the Senate would require suicide prevention training for doctors, nurses, naturopaths, chiropractors and other primary healthcare providers. (This training would take up six of the continuing education hours already required.) No other state has passed similar legislation. Two years ago, Washington became the first state to require suicide prevention training for counselors, social workers and other mental health professionals. A couple of other states have already followed suit.

Why is this happening here? "I was approached by [University of Washington assistant professor of social work] Jennifer Stuber," explains state Rep. Tina Orwall, the prime sponsor of both suicide prevention training bills. "Her husband had just completed suicide." (In suicide prevention circles, one doesn't speak of "committing" suicide. One "commits" a crime, which is what suicide has traditionally been considered. One does not "commit" a public health problem, which is how they want suicide to be seen now.)

Stuber's husband had seen professionals, says Orwall, but "the people he had sought help from really hadn't been trained." After her husband's death a few years ago, Stuber approached Orwall. Last year, Stuber co-founded the UW-based suicide prevention group Forefront, which has organized a lobbying day Tuesday in Olympia.

Before introducing any legislation, Orwall says, she and Stuber "really built a coalition." Two years ago, they introduced and passed the “Matt Adler Suicide, Assessment, Treatment and Management Act of 2012″— named in honor of Stuber's late husband — which required training for mental health professionals. But some professional groups, including doctors and nurses, didn't want the law applied to them at the time, and they were left out. "This year, we're taking the big step, which is around providers," Orwall says.

Although the bill sailed through the House with only three "no" votes, in the Senate, it faces "a fair amount" of pushback. She explains that professional associations still don't want anyone telling them what to do. And some conservative legislators don't like government telling anyone what to do. In House testimony, opponents also raised concerns about the costs.  

Some people have wondered if knowing the questions to ask potentially suicidal patients would increase a practitioner's liability for patients who killed themselves, says Lauren Davis of Forefront. Ironically, Davis says, "the reality is you're liable now if you don't ask."

The Washington State Psychiatric Association opposes the legislation. In an open letter, the association's president, Daniel Crawford, argues that given the number of people who kill themselves every year and the trauma their deaths cause survivors, "the option of inaction is unconscionable," but that "evidence for effective ways to prevent suicide remains frustratingly limited." Crawford quotes a nine-year-old Journal of the American Medical Association(JAMA) article which concluded that physician "education in depression recognition and treatment and restricting access to lethal methods reduce suicide rates," but "[o]ther interventions need more evidence of efficacy."

As Crawford acknowledges, the statistics are pretty staggering. "Some 38,000 people killed themselves in the United States in 2010," the magazine Nature recently observed, citing a February report by the National Action Alliance for Suicide Prevention. "That’s more than were killed in traffic accidents (34,000) or by prostate cancer (29,000), and more than twice the number murdered (16,000)."  Nature also reported, "Since 2008, the suicide rate among soldiers has exceeded that of the general population, and in the past few years the army has lost more soldiers to suicide than to combat."

Rates have risen in the civilian workforce, too. Paul Quinnett, a psychologist who runs a Spokane-based suicide prevention training institute and has been a clinical assistant professor in the UW Medical School's department of psychiatry and behavioral science, observes that rates have gone up among people of prime working age, between 25 and 55 since the start of the recession. He says that every 1 percent rise in unemployment is matched by a 1 percent rise in suicides.


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Comments:

Posted Mon, Feb 24, 8:21 a.m. Inappropriate

Are these legislators attempting to legislate what medical professionals do in the cases involving those who want to end their life rather than endure terminal pain and illness?
If so, quit imposing your morality on others!!

Posted Mon, Feb 24, 9:44 a.m. Inappropriate

No, this bill does not limit the ability of terminally ill patients and medical professionals to invoke the Death With Dignity Act to end their lives in a carefully considered time frame and manner. It simply asks primary care providers to start learning to ask questions, make referrals and take other actions to help their patients (and those who love them) find hope and help to go on living.

suej

Posted Mon, Feb 24, 9:13 p.m. Inappropriate

Building awareness of suicide risk will do nothing but increase the misery as long as suicide prevention remains part of a toxic, coercive mental health system.

nordy

Posted Mon, Feb 24, 9:14 p.m. Inappropriate

why don't you make it possible to comment by using legible "recapta" terms?

nordy

Posted Tue, Feb 25, 10:01 a.m. Inappropriate

Thank you for noting that using the term "committed" when referencing a suicide is offensive.

Being able to identify suicide risk signs is a valuable skill for everyone to possess. Whether or not it translates into reduced completions or compliance with treatment is another story.

I am a parent of a 20 year old son who died by suicide. My job was in the mental health field. I recognized the dangers immediately and did all in my power to save him. He resisted treatment because the side effects of the medication were intolerable to him.

I would have jumped in front of a speeding train if it would have prevented his death. I had all the best-practices knowledge at my fingertips, access to the best psychiatric care and facilities, and still the decision lay in the hands of one person only: my very ill and suffering son.

Taking self-determination away from adults through legislation often produces unintended consequences. When an adult is determined to take their own life, they usually find a way to succeed eventually. We cannot legislate forced treatment, forced medication acceptance, or forced outcomes, no matter how well-intended.

gaia

Posted Tue, Feb 25, 2:02 p.m. Inappropriate

I see a Doctor occasionally. My visits are largely paid for by Medicare so I may be an exception but I wonder how many things a doctor and his staff are expected to observe in a ten minute consultation. First, my doctor has to review medications, recent tests, do a quick check of some basics (heart rate, blood pressure, listen to my lungs a bit), meanwhile pursuing the reason for the visit-- which may be complex.
Perhaps perceiving a mental state that is susceptible to thoughts of suicide should be easy and should be done simultaneously with an exam for dizziness, loss of memory, painful metatarsal, etc., but I would rather have my fine doctor concentrate on why I called and made an appointment, not on some unstated risk factor.

kieth

Posted Tue, Feb 25, 2:19 p.m. Inappropriate

People who kill themselves do so for a reason and I can accept that. What I have trouble accepting is that the decision to end one's life means the person needs medical help. That's a load of crap, they made a personal choice. Instead of wasting resources and fighting this person, we should honor their decision and implement something akin to the Death with Dignity law. Check in check out.

Bottom line, just another waste of legislative time, when there are important issues in this state that need urgent attention. Let them go, it's what they want.

Djinn

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