How Primary Care Providers Can Better Support Individuals Living at Risk for Suicide

When I visited my primary care provider (PCP) for a sprained ankle that just wouldn’t heal, they worked with me to figure out care options and plans. After asking questions about how I was injured, what home remedies seemed to help or hurt, and how the injury had impacted my life and wellbeing, I was assisted in finding specialists, ordering tests and imaging, repairing the ankle via surgery, and following up with outpatient physical therapy. While my ankle still aches on occasion, I have a self-care maintenance plan, and I am able to maintain a meaningful and enjoyable life.

When I went to my PCP, they never questioned whether I was in pain; they didn’t let their emotions (or ego) take over, and they were involved throughout the care process. Over months of treatment from specialists, my PCP remained in steady and consistent contact throughout my treatment. At no point in the process was I expected to diagnose myself, prove myself, or find my own specialists.

Why should it be any different for persistent mental health concerns? Would I receive the same thoughtful care if I visited my PCP for suicidal ideation (SI) or any other mental health concern?

Challenges Faced by Patients With Chronic Suicidality

I have struggled with mental health and psychological pain most of my life, including adverse childhood experiences, trauma, surviving multiple suicide attempts, living with chronic SI, and losing loved ones to suicide.

It can be a challenge for me, and for many others who struggle with suicidality, to ask a PCP for help addressing SI. The heaviness of depression, the pressure of anxiety, and the immobilization of despair, can leave me struggling to find words to express my concerns and adequately advocate for myself.

There are times I can read books, listen to podcasts or mentors, try new habits, and engage in other distractions such as home remedies. However, there are seasons when I struggle to sustain hope, and the will to do basic tasks escapes me; it can take all my effort just to show up to an appointment with my PCP. Fear of being a burden, misunderstood, or forced to follow a treatment plan I don’t agree with, consume my thoughts and restrict wise actions.

During such times, I need the caring collaboration of a provider who will treat my psychological pain as thoughtfully and as thoroughly they would an ankle injury.

The Importance of Compassionate, Whole-Person Assessment and Care

At most PCP visits, regardless of the reason for the visit, patients are asked to complete a form to assess their mental health. Responses are not always reviewed with patients in real time, which can result in missed opportunities for providers to identify and learn more about their patient’s mental health concerns.

I returned to the PCP who cared for my ankle with the intention to ask for medication to assist with ongoing mental health struggles and SI. We did not review my mental health assessment together, but the PCP directly asked what I was hoping to address during the visit.

I shared about my anxiety symptoms and recent upticks in panic attacks that were starting to take a toll on many parts of my life, and through tears, said that I would like medication to help. My PCP asked if I had tried anything before to address these concerns. I nodded and requested a medication I had taken previously. While maintaining a calm composure, they softened their posture, made eye contact, and asked with a curiously compassionate tone, “Is there something else you wanted to share?” I kept my response short, “I’m just worried about taking this medication again,” and they asked if there was a reason why.

I really appreciated their ability to keep the conversation open and nonjudgmental. “It’s just a medication I’ve struggled with in the past. It’s one of the only medications I’ve found that helps, but I have had trouble with it before,” I shared, staying vague for fear they would rescind their offer and force me to an inpatient hospital if I continued to speak.

I had been treated several times in an inpatient setting, both voluntary and involuntary; each time, there were “side effects” to staying in the hospital that resulted in more distress. Things like being strip searched upon admission, witnessing the struggle in other patients, constant hovering safety checks every 15 minutes, forced medications, limited visiting and outdoor time that deepened my sense of isolation, and the sense that I was falling behind in my obligations of daily life. Inpatient stays resulted in missed work, reduced income, needing others to help watch my home and pets, and a general sense of being disconnected from society.

While I do believe inpatient hospitalization saved my life in times of active crisis and needed medication adjustments, not all hospitals offer effective care for chronic SI. In fact, I know that there are limited studies on whether hospitalization actually helps to reduce suicide risk, and several studies have even suggested for some people it can cause an increased risk for suicide and other negative outcomes (Jobes, 2025; Ward-Ciesielski & Rizvi, 2021).

Afraid I had already shared too much, I waited for the instruction to seek “higher level care.” Instead, they simply responded, “tell me more…” Sensing I had some autonomy and support in the conversation, I felt comfortable sharing more of what was going on.

Treat Effectively and Transition With Transparency

After sharing more about my prior suicide attempts, medication misuse, and inpatient hospitalizations, they assured me that they would fill the script to help with my most concerning symptoms. They then provided me with a list of psychiatric and counseling providers and scheduled a follow-up. They emphasized how the referrals were vetted and said if I had any trouble finding someone to work with, that they would continue to support me throughout the process.

Feeling my PCP’s trust in me and that they would be there to support me along the way, I was able to act and get connected with effective specialists. When experiencing the distress of intrusive thoughts and urges, navigating a fragmented health care system to access necessary care can be overwhelming. My PCP thankfully saw that I was at capacity, and they did not ask me to carry this burden on my own.

That saved my life. It wasn’t that the PCP had all the answers or provided all the care; it was simply that they assured me we would find and access the right care for me.

Effective Strategies for Suicide Prevention in Primary Care

PCPs don’t expect someone with a physical issue to self-diagnose, locate specialists, develop their own treatment plan, or remember to follow up. We shouldn’t expect someone experiencing suicidal thoughts/SI to do those things either.

Suicide prevention in primary care settings doesn’t require that every PCP become an expert in suicide care. PCPs can make a difference by taking a whole health approach — one that brings the same curiosity, compassion, and coordination to every patient, and strives for continuity of care, regardless of whether they are experiencing pain physically, emotionally, or both.

Ways PCPs can support patients with suicidal ideation:

• Ask direct, nonjudgmental questions.
• Review mental health assessments together.
• Provide vetted referrals and follow-up.
• Create safety plans with patients.
• Maintain consistent communication.

Tip for PCPs: Ask direct, compassionate questions about mental health and suicide risk, and listen nonjudgmentally.

1. Ask.
A patient can be overwhelmed and unsure of how to bring up what they’re experiencing. Don’t pressure someone into sharing more than they’re comfortable disclosing. If you need more information, ask from a place of humility and clarity. Don’t shrink away or ask things like, “you’re safe now, right?” or “you don’t think you’d actually go through with it now, right?” And don’t force perspectives that could be a soft invalidation of the person’s experience in the moment. Things like “but you have so much to live for,” or “this too shall pass,” don’t help.

Ask direct questions that create openings for more thorough assessment. When a concern is raised or identified, consider conveying to them, “You’re not alone and I’m honored you shared with me. I value your trust and am here to help. Can I ask a few more questions so we can work together on how to best support you?”

PCPs can also review or create safety plans with their patients to identify ways to keep them safe between visits and beyond. The Stanley Brown Safety Plan or Crisis Response Plan are two examples. They address: What are the patient’s warning signs? Who are their contacts (including the PCP’s office and other community resources)? Where could they go if they were in crisis? When should they reach out for more help?

Resource: Consider using the Stanley Brown Safety Plan or Crisis Response Plan for patient safety.

2. Listen.
How a provider responds when SI is disclosed makes a difference. Patients are people, not a risk category. Don’t assume that someone with SI is sharing for attention, that they don’t want to live, or that they haven’t already tried several methods to improve their circumstances. And don’t assume the same solutions will work for every individual.

Lecturer Beth McKinney with eCornell encourages providers to remain “ignorantly curious,” as we engage with individuals about their wellness goals and concerns (McKinney, 2025). Listening is an opportunity to learn more about the individual experience, rather than getting caught up on diagnosis and problem solving.

3. Stay Connected.
PCPs can be a consistent presence for patients as they navigate health care systems, and they can maintain active connections with referral sources to strengthen networks of care. Learn more about peer support networks and community resources — and be the bridge for patients in your care.

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Don’t assume that just because a patient doesn’t revisit SI in the future that they’re “cured.” Living with chronic SI has helped me develop coping strategies that help me through most seasons, but sometimes I still need the help of a professional to recalibrate. Though it may initially feel uncomfortable, ask: “Have you had thoughts of suicide lately?”

When a PCP takes initiative to follow up on SI, it can be its own form of treatment — a small way of showing you’re still in this together and that the conversation is always open.

PCPs play a unique role in identifying and caring for individuals with SI. They can be a meaningful point of contact for someone with mental health needs over a long period of time — and can truly be integral to either relieving someone’s pain or adding to their burden.

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Sara Do, CPS-MA, serves on the CAPES Lived Experience Advisory Board at UMass Chan Medical School and contributes lived-experience expertise to suicide prevention research and systems improvement in collaboration with the Zero Suicide Institute at EDC.

References

Jobes, D. A. (2025). Fear of suicide, control, and effective hospitalizations: Inpatient care for suicidal risk should rely on effective treatments. Psychology Today. https://www.psychologytoday.com/us/blog/the-psychology-of-life/202508/fear-of-suicide-control-and-effective-hospitalizations

McKinney, B. (2025). Understanding the deeper need [Online course]. eCornell, Cornell University. https://ecornell.cornell.edu/courses/health care/understanding-the-deeper-need/

Ward-Ciesielski, E. F., & Rizvi, S. L. (2021). The potential iatrogenic effects of psychiatric hospitalization for suicidal behavior: A critical review and recommendations for research. Clinical Psychology: Science and Practice, 28(1), 60–71. https://doi.org/10.1111/cpsp.12332