Identifying Suicide Risk
by Nancy Morton, B.S.
Due to the recent suicides that have occurred in Missouri’s medical community in the last year, I have been eager to learn more about what can be done to prevent such tragic losses. During a recent AMA webinar on Suicide in Medical Education: The Stresses of Medical School and Residency Training, I was pleased to learn that the UC San Diego Health System has an innovative program called Healer Education Assessment and Referral or HEAR, which is designed to identify and assist students, residents, fellows and faculty members who are depressed and may be at risk for suicide. 
Their process begins with an invitation to participate in a web-based, brief, anonymous, confidential survey. Each respondent is then grouped according to their responses in 3 tiers based on risk level with Tier 1 as the highest risk category. A counselor reviews all questionnaire responses and responds with a personalized reply based on their individualized assessment. The counselor invites each respondent to communicate online if desired via an anonymous website dialogue page. All Tier 1 and 2 students are urged to contact the counselor to schedule an in-person evaluation. The counselor then evaluates the participant more fully, discusses treatment options, and makes referrals as appropriate.
The most encouraging result I found is that all those categorized as high risk agreed to be referred to a mental health professional for further evaluation and treatment, and 73% of the moderate risk group accepted referral. Further, participants who subsequently submitted an evaluation report after the first meeting with a counselor, indicated that they would not have made an appointment to see a mental health professional without the online screening program.
A few of the revealing comments that were made during the post-survey evaluation were: This program “validated my feelings of being overwhelmed/burnt out, and made me feel more OK with seeking help. I hope this program is continued.” Another was “by completing the online questionnaire, I was finally able to let someone know how badly I was feeling without any judgment and in a confidential manner.” Thirdly, “this program was an important factor in getting me to seek treatment.” My hope is that this effective program may inspire other medical schools and other medical systems to duplicate such efforts.
1 Sidney Zisook, MD, and Michael F. Myers, MD, Suicide in Medical Education: The Stresses of Medical School and Residency Training, AMA webinar conducted October 5, 2011.