Suicide rates have increased in almost all 50 states and in all regions of Washington State. The health care community in Washington State has been concerned about the too-high suicide rates for years. Suicide is a preventable outcome, and our community is working to address this public health imperative through our Suicide Care workgroup. The Bree Collaborative is named after Dr. Robert Bree, a radiologist and leader in the imaging field who himself died by suicide.

Our Suicide Care workgroup is made up of family members, psychologists, psychiatrists, Department of Health employees, researchers, and other clinicians who believe that health care systems can and should play a key role in helping to identify and treat patients at risk of suicide. Patients are often are seen in primary care and other health care settings in the month prior to death. Our recommendations for health care organizations are to systematically ask patients about suicidal thoughts and routinely screen for suicide risk factors, including depression, anxiety, and alcohol and drug use. For patients who have frequent thoughts about suicide or other risk factors like a prior suicide attempt, we recommend suicide risk assessment with a validated instrument followed by management of suicide risk by engaging patients in collaborative safety planning. Safety planning (or Crisis Response Planning) includes asking patients about lethal means like guns and medications such as opioids, anxiety, or sleeping medications, and helping them reduce their access, through plans to lock up guns or store them outside their homes and/or store limited quantities of medications at home. Safety planning also means involving trusted friends, family members, clinicians and crisis contacts as key supports and ensuring that patients have access to mental health treatment. We recommend treatments that directly target suicidal thoughts and behaviors and other psychiatric vulnerabilities like depression, substance use disorders, and other mental health conditions. Patients should have access to treatment offered through integrated mental health in primary care settings and/or through a supported referral to an external provider. For individuals who attempt suicide and survive, it is critical these patients receive appropriate and timely follow-up care. This should include supported transitions from inpatient (hospital) to outpatient settings, collaborative safety planning, and ensuring the patient has a health care team in place to provide evidence-based follow-up treatment. We hope that setting an agenda with recommendations for clinicians and health care delivery systems will provide a pathway towards better quality suicide care.

Talking about mental health is a first step to reducing the stigma surrounding suicide. Several great resources for health care organizations and providers include the National Action Alliance for Suicide Prevention’s Zero Suicide initiative, the American Foundation for Suicide Prevention and Now Matters Now. Find out more about the Bree Collaborative here.

If you or a friend or family member needs help call the Suicide Prevention Lifeline 1-800-273-TALK (8255) or text CONNECT to 741741.


Julie Richards, MPH, Research Associate
Kaiser Permanente Washington Health Research Institute
Suicide Care workgroup member

Jeffrey Sung, MD, Member
Washington State Psychiatric Association
Suicide Care workgroup member

Ginny Weir, MPH, Director
Dr. Robert Bree Collaborative