Ask the Right Question
SAVE A LIFE
Primary Care Physicians Can Guide Patients in Crisis to Healing
Sometimes all it takes to save a life is asking the right question: “So how’s your mood?”
It’s a question that primary care physicians should always ask their patients, says Matthew Wintersteen, PhD, director of the David Farber ASPIRE (Advancement of Suicide Prevention, Intervention, Research, and Education) Center at Jefferson and associate professor in the Department of Psychiatry and Human Behavior.
Wintersteen says in the battle against suicide, the first line of defense is not always the mental health professional, but often a primary care doctor.
“In outpatient psychiatry or psychology, we see a very small fraction of the total population who are at risk for suicide,” he says, noting that the stigma of suicidal thoughts often prevents an individual from seeking help from a mental health professional. “But they do go to their doctors when they’re sick or need a checkup, and that’s an important opportunity that shouldn’t be missed.”
Unfortunately, it is often missed.
“In medicine, we typically start with, ‘Tell me what’s wrong,’ or ‘What brings you in today?’” Wintersteen says. “When working with someone who is suicidal, those questions can be interpreted as ‘Tell me all the things you’re ashamed of,’ which is a terrible way to start a conversation.”
Many people are afraid to talk about it, he says: “If they have thoughts of suicide, they may feel ashamed and don’t want to share that with other people.”
Wintersteen says primary care physicians can ease patients into a discussion by simply asking: “So how’s your mood?”
“It gives them a chance to feel heard by someone they trust, and that their experience is going to matter,” he says. “It makes it a lot easier to then have a conversation about the things that they’re struggling with.”
He also suggests never telling a patient “It’s going to be okay,” because the doctor has no way of knowing that. Instead, reassure the patient by saying: “We’re going to do everything we can to help you feel better.”
The healing process includes finding the kind of care offered at the David Farber ASPIRE Center, which focuses on advancing evidence-based therapy, innovative research, and high-quality education for the next generation of therapists, healthcare professionals, and community members.
The David Farber ASPIRE Center opened in 2022 through a generous donation from the Farber family, who also helped establish the Vickie and Jack Farber Institute for Neuroscience at Jefferson in 2002.
“The David Farber ASPIRE Center is set to be the gold standard for both clinical care and research across the country,” Wintersteen says. Perhaps the most unique aspect of the Center is that it sees only the most at-risk patients in an outpatient setting.
“The people typically seen at the David Farber ASPIRE Center are those who have made suicide attempts within the past three months, or who have been actively thinking about suicide within the past month,” Wintersteen says. “Many of my colleagues in psychiatry would hospitalize the patients we see in an outpatient practice, because they are high-risk. Yet, after a year in existence, and more than 100 patients, we’ve had a total of two suicide attempts—both of whom immediately reached out to us for support, and both of whom got the help they needed and are doing well.”
When patients arrive at the Center, they go through a comprehensive intake process using an evidence-based approach; the team then determines the factors driving their suicidal experience and pinpoints the best treatment for that person.
Wintersteen says that treatment is not a one-size-fits-all kind of process. “What works for Jane might not work for Mark. We fully recognize that some treatments—while there’s ample evidence to suggest they’re effective—may not work for everybody.”
Patient care is linked to the research being conducted at the Center, in an effort to continually improve methods and outcomes.
“From day one, we are collecting data from individuals who come in for appointments,” Wintersteen says. “And throughout the course of their care, we’re able to follow, track, and collect additional data to evaluate changes in outcome.”
Creating a data repository enables the team to determine the success of interventions and enhance treatment.
In addition to patient care and research, education also plays a major role at the David Farber ASPIRE Center, providing suicide prevention programs for physicians, nurses, office support staff, and the general public.
In collaboration with the Prevent Suicide PA Online Learning platform, training sessions are free or low-cost, and feature content such as risk assessment, safety planning, and trauma-informed care.
Also, through the support of the Pennsylvania Office of Mental Health and Substance Abuse Services, the Center hosts both clinical and research fellowships.
The Center is growing in both size and reputation and has ever-increasing goals. However, financing those goals is always a challenge, and depends heavily on philanthropy.
“Philanthropy is critically important to the work that we do. It allows us to see people who are uninsured or underinsured. It allows us to provide training for individuals who can then take the level of care they’re learning out to the community. It disseminates the work we’re doing to a broader audience.”
While the Center accepts most forms of insurance, it is designed to work with anyone in crisis.
“If you come in and you don’t have insurance, or if you are underinsured, or if you have no means to pay for your care, we’re still going to do everything we can to provide you the same level of care as anyone else,” he says, noting that this is possible only through philanthropy.
But that care can only happen when those in crisis are identified—and that is where the primary care physician comes in, Wintersteen says.
“Check in with them when they come in for their annual visits and ask them questions about their behavioral health. Ask them about depression, ask them about anxiety, and if you are concerned about them, it’s okay to ask them if they’re having thoughts of suicide or have engaged in behaviors to make a suicide attempt,” Wintersteen says.
If a patient does express suicidal thoughts, the physician needs to keep them engaged.
“The worst thing you can do at that moment is to say, ‘Let me get you connected to somebody else.’ What that says to the patient is that I can’t handle it and somebody else should deal with it.”
Patients need to know their doctor is listening to them and that what they’re saying is important, Wintersteen says: “Though a family physician is not a psychologist or psychiatrist, we want patients to know that primary care can be a resource for connecting with somebody who can help them create a life that’s worth living again.”
Ask the question, urges Wintersteen, because “if we avoid talking about suicide in other areas of medicine, we further stigmatize it, and people simply don’t get better.”
The David Farber ASPIRE Center will host an Open House on December 5, please visit the event registration page to learn more.
For more information about the David Farber ASPIRE Center, visit jeffersonhealth.org/ASPIRE or call 215-503-7077.