14-07-2021 | Mental health | Feature | Article

Creating a safety net: How doctors can help suicidal patients

Having considered the risk factors and red flags for suicidal ideation, what should healthcare professionals do to identify and support people with diabetes who are having suicidal thoughts?

Here is a brief overview of the steps healthcare providers can take, guided by Mary de Groot (Diabetes Translational Research Center, Indiana University School of Medicine, Indianapolis, USA).

Screen, screen, screen!

The majority of people experiencing depression and/or suicidal thoughts will appear outwardly as normal
Regular screening – even just regularly asking – is the only efficient way of detecting suicidal ideation
Asking about suicidal ideation will not plant the thoughts in patients’ heads

In fact, it’s quite the opposite. When we screen for suicidal thoughts, or plans, many people are relieved to talk about these very scary experiences that they’re having internally, but that have a tremendous amount of stigma associated with them, and that it may not have been safe to talk about with others.

Mary de Groot

Get up to date on protocols

All healthcare centers have protocols for emergency situations, including high suicide risk
Become familiar with these and have the confidence to act appropriately should the occasion arise

We are not helpless! We have plans for these kinds of things; if we don’t happen to know what our healthcare environment plan is, then it is our responsibility to find that out.

Mary de Groot

Practice person-centered care

Aligns care goals between the person with diabetes and their healthcare provider
Empowers the person with diabetes to raise and prioritize issues of greatest importance to them, including mental health
Can help to reduce diabetes distress

Whenever you are meeting with a patient, there are two experts in the room. You bring the medical expertise; your patient brings their lived experience with diabetes.

[“What would you like to discuss today?”] is a very simple question we can ask that gives us good information that we need as healthcare providers and can mean the world to our patients in terms of feeling understood and valued for the expertise that they bring.

Our patient has the opportunity to change the script, the relatively passive script that they typically play in a medical encounter. They get to name what’s important to them; it jogs their thinking to get out of that passive role.

Mary de Groot

Facilitate multidisciplinary care

Complementary areas of expertise ensure holistic care for people with diabetes, to help address all their concerns
Team approach is especially important for the small minority of patients with high levels of emotional dysregulation

It’s important that we collaborate and we coordinate our care to create that safety net for the patient.

Mary de Groot

Consider a behavioral contract

Appropriate for a small number of high-risk people using insulin
May cover misuse of insulin and the feelings leading up to insulin misuse – when to seek help

We want to ask the questions so we can clearly evaluate our patient’s medical and emotional presentation. Is this somebody who just misjudged their insulin, and that resulted in a severe hypoglycemic episode? Did the patient intentionally omit their insulin for other reasons? Or is this someone who is in a state of emotional dysregulation and who needs additional support?

Mary de Groot

Medicine Matters Diabetes