Are You a Mental Health Gatekeeper?

What to Know About How You Can Help

Gatekeepers to care are urged to take all suicide threats and all suicide attempts seriously. A past history of suicide attempts is one of the strongest risk factors for death by suicide. The gatekeeper process includes these steps:

1. Ask directly

  • "Are you thinking about killing yourself?”
  • “Have you ever tried to hurt yourself before?”
  • “Do you think you might try to hurt yourself today?”
  • “Have you thought of ways that you might hurt yourself?”

This questioning won’t increase the person’s suicidal thoughts; it will give you information that indicates how seriously or frequently the person has thought about killing him- or herself. Studies suggest that acknowledging or talking about suicidal thoughts can reduce rather than increase the chances of a person's following through on them. And the more you can learn, the better. As confirmed by a recent Mayo Clinic study, a non-fatal suicide attempt is a strong risk factor for subsequent suicide death.1

2. Show you care

  • “I take what you’re saying seriously.”

Even if the a patient expresses a fleeting thought or comment, they need to know that someone is listening and can act in their interest to help.

3. Manage the means

  • “Do you have pills or firearms in the house?”

Take steps towards reducing their access to firearms or harmful medications. You might need to enlist the support of the patient’s loved ones to assist in reducing such access. Not surprisingly, access to guns represents the deadliest risk.2

4. Act

  • “I’m going to get you some help.”
  • “Here are some therapists you can talk to right now.”

If you think someone might harm him- or herself, do not leave them alone. Here are some specific actions you can take:

In person: Stay with your patient until they are with someone who is prepared to help them. If the resources are available, a physical handoff to a psychiatric professional is ideal. If not, connect them with the nearest appropriate mental-health resource. If you are their primary-care doctor, consider how you can coordinate with a mental-health specialist, and ensure that the necessary follow-up takes place beyond the crisis.

By phone: If you do not have local resources immediately available, call the National Suicide Prevention Lifeline, available 24/7, at 1-800-273-TALK. You and/or your patient will be connected to the nearest available crisis center for more support in your area.

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