Providing Patient-centered Suicide Care in Integrated Primary Care Settings

The conversation around suicide is changing. Growing public dialogue about mental health, increased attention to suicide prevention campaigns, and rising engagement with the 988 Suicide & Crisis Lifeline (SAMHSA, 2026) point to a cultural shift in how Americans understand and talk about suicide. This shift reflects a broader move away from the stigma and silence that once surrounded the topic.

This increasing awareness also means a greater need for accessible resources and knowledgeable professionals. Primary care clinics are often where patients first raise mental health concerns and should provide screening and brief interventions for suicide risk. Integrated primary care and behavioral health settings are particularly well-suited to go beyond screening and brief intervention, offering follow-up after a positive screen and comprehensive services that engage patients with suicidal ideation in high-quality, evidence-based mental health care to reduce future suicide risk. 

The Critical Role of Primary Care Providers

Research indicates that 83% of people who die by suicide have seen a primary care provider within the year before their death, while 44% had contact with a provider in the month prior (Stene-Larsen & Reneflot, 2019). However, some patients do not openly share their thoughts of suicide. They may come in for an annual physical, with complaints about headaches or showing flu symptoms, while also being at risk for suicide. Unless providers ask, they may not identify this risk. That is why primary care practices present a critical opportunity to screen people for suicidal thoughts and behaviors and have protocols in place to respond should someone screen positive.

While discussing mental health is becoming more commonplace in primary care practice, directly asking about suicidal thoughts is uncomfortable for some providers. Many health care providers have had little to no training in suicide care.

This has been assessed through the Zero Suicide Workforce Survey, which has been given to staff at over 700 health care organizations worldwide. Of the 20,000+ respondents who are responsible for delivering treatment, fewer than half report receiving training on suicide-specific evidence-based treatment approaches. Moreover, only one-third feel knowledgeable on warning signs for suicide, and only one-third are confident in providing treatment to patients with suicide risk (Grumet et al., 2019).

Understanding Interventions and Barriers

Any health care practice should be able to identify someone at risk for suicide. Primary care practices should develop competence with suicide screening. If someone screens positive for suicide, then providers should activate brief interventions to reduce that risk, such as safety planning. Risk screening and safety planning improve outcomes for people seen in primary care settings (Angerhofer Richards et al., 2024).

Collaborative safety plans are a critical practice that can be integrated in primary care. The commonly used Stanley-Brown Safety Plan template provides step-by-step guidance on what to discuss with the patient. Beyond tailoring the safety plan to the patient’s unique needs and situation, it is crucial that the patient understands the plan’s value and intends to use it.

Lethal means safety should be part of the conversation. This includes asking patients directly if they have access to any object, tool, or method that can be used to carry out self-harm or suicide, such as a firearm, sharp object, medications or poisons, even if they haven’t mentioned it. Taking this conversation one step further, some health systems and primary care practices are distributing firearm locks (Novotny Owen, 2025) or medication locks (OHSU, 2018; United Counseling Service, 2025) at the point of care, immediately reducing risk.

These brief interventions are effective, but only when part of a genuine, meaningful conversation. Interventions require providers to be persistent, empathetic and instructive as to what to do next. Potential barriers or challenges to using the safety plan, locking up firearms or accessing mental health treatment should be discussed, with solutions identified.

Despite increased awareness of crisis services, there are barriers preventing individuals from reaching out for help. Fear of out-of-pocket costs, availability of in-network providers and stigma associated with help-seeking are the biggest obstacles to seeking treatment (Bipartisan Policy Center, 2021).

The patient has already done the hard part — sharing their suicidality. Programs should ensure that all providers have the training to deliver these interventions. Patients and their families need and deserve health care providers that offer comfort, skill, competence and hope.

To learn more about integrating suicide care into your practice and/or health system, visit:

Emerging Best Practices for Addressing Suicidality in Primary Care | The Integration Academy

Toolkit | Zero Suicide

Best Practices Registry | Suicide Prevention Resource Center

References

Angerhofer Richards, J., Cruz, M., Stewart, C., Lee, A. K., Ryan, T. C., Ahmedani, B. K., & Simon, G. E. (2024, November). Effectiveness of integrating suicide care in primary care: Secondary analysis of a stepped-wedge, cluster randomized implementation trial. Annals of Internal Medicine, 177(11), 1471–1481. https://doi.org/10.7326/M24-0024

Bipartisan Policy Center. (2021, October). Mental health and substance use treatment services utilization. https://bipartisanpolicy.org/wp-content/uploads/2021/03/BPC-MC-FINAL-Slide-deck-on-Mental-Health-Analysis-Poll.pdf

Grumet, J. G., Hogan, M. F., Chu, A., Covington, D. W., & Johnson, K. E. (2019, January-February). Compliance standards pave the way for reducing suicide in health care systems. Journal of Health Care Compliance, 21(1), 17–26. https://theactionalliance.org/sites/default/files/hccj_0102_19_grumet_0.pdf

Novotny Owen, K. (2025, June). Mitigating suicide risk with firearm access screening, open dialogue, and secure storage. EpicShare. https://www.epicshare.org/share-and-learn/kp-washington-gun-safety 

OHSU News. (2018, September 13). Lock it up to save a loved one’s life. Oregon Health & Science University. https://news.ohsu.edu/2018/09/13/lock-it-up-to-save-a-loved-ones-life

Substance Abuse and Mental Health Services Administration. (2026, May 15). 988 Lifeline performance metrics. U.S. Department of Health and Human Services. https://www.samhsa.gov/mental-health/988/performance-metrics

Stene-Larsen, K., & Reneflot, A. (2019, February). Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017. Scandinavian Journal of Public Health, 47(1), 9–17. https://doi.org/10.1177/1403494817746274 United Counseling Service. (2025, July 25). UCS provides free lockable medication bags and firearm locks to the community. https://www.ucsvt.org/latest-news/ucs-provides-free-lockable-medication-bags-and-firearm-locks-to-the-community/