This first appeared in STAT News, by: Roshni Koli and Christine Yu Moutier.
Suicide rates in the United States increased by approximately 36% between 2000 and 2022, according to updated data from the National Center for Health Statistics. Suicide was responsible for just under 50,000 deaths in 2022 (the last year with complete statistics) — an all-time high. As this appalling trend continues, offering mental health assessments and care in primary care settings could help save lives.
As physicians, we pride ourselves on being able to care for patients by way of our knowledge, skill, and expertise. It’s frustrating and disempowering when we can’t help an individual who needs mental health care due to a shortage of effective, affordable, and culturally competent mental health providers. Members of the U.S. Senate and House of Representatives are working to address this barrier with the Connecting Our Medical Providers with Links to Expand Tailored and Effective (COMPLETE) Care Act, federal legislation that would bring mental health care into primary care visits to address this gap.
The COMPLETE Care Act would do this by giving healthcare providers incentives to implement integrated care models, such as the Collaborative Care Model, considered the gold standard of integrated care. It works like this: Collaborative care brings together physical and mental health care treatment in a primary care provider’s office. In this integrated care approach, a primary care provider, a psychiatric consultant, and behavioral health manager work together to detect and provide established treatments for common mental health problems, measure their patients’ progress toward treatment targets, and adjust care when appropriate.
Nearly half of individuals who die by suicide saw a primary care provider within a month of their death, highlighting a critical window of time to identify and help people having suicidal thoughts or behaviors. Every primary care visit is an opportunity to identify suicide risk and potentially save a life. Yet suicide risk is largely undetected in primary care settings.
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There is consensus among suicide prevention organizations on the need to implement routine suicide screening for adults in primary care settings — just as the U.S. Preventive Services Task Force recommends for anxiety and depression — to bridge a long-existing divide between the approach to mental and physical health. The two are inextricably linked, and screening with a simple question like “In the past week, have you been having thoughts about killing yourself?” can make a lifesaving difference. It’s a key first step in a clinician’s process of identifying individuals who are at risk of suicide and deploying risk-reducing actions.
Integrated models like the Collaborative Care Model have been shown to detect and prevent suicide and overdose in primary care before the point of crisis. This approach is particularly adept at detecting mental health conditions such as depression because it incorporates another proven approach: measurement-informed care that tracks patient progress over time and uses data to inform treatment, much like routinely checking a patient’s blood pressure and cholesterol.
In more than 90 randomized clinical trials, collaborative care showed strong evidence of identifying and treating depression, anxiety disorders, and substance use disorders, all major risk factors for suicide. According to research from the Meadows Mental Health Policy Institute, which one of us (R.K.) works for, if every person in the United States living with depression had access to this model of care, up to 14,000 lives could be saved every year, lowering current suicide deaths by as much as 28%.
Collaborative care is also financially sustainable. New research by Penn Medicine and Independence Blue Cross shows that integrating mental health care into primary care does not increase overall costs for insurers.
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Despite its proven effectiveness, adoption of integrated care models has been frustratingly slow due in part to concerns around startup costs associated with implementation, even though the big picture shows overall cost savings.
Currently, we estimate that fewer than 5% of people in the United States have access to collaborative care. As physicians who have dedicated our lives and careers to preventing suicide, we can no longer accept the status quo when we know there are proven ways to prevent these deaths. Integrating behavioral health care into primary care won’t solve all the problems of our beleaguered mental health system, but it will identify more people at risk of suicide and open pathways to care for them.
Integrated health care is long overdue. It is time for physicians, hospitals, and health systems to embrace it. We urge Congress to help them do so.
Roshni Koli, M.D., is the chief medical officer at the Meadows Mental Health Policy Institute. Christine Yu Moutier, M.D., is the chief medical officer at the American Foundation for Suicide Prevention.
If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: call or text 988 or chat 988lifeline.org.
For TTY users: Use your preferred relay service or dial 711 then 988.
