While deaths in the United States due to heart disease, diabetes, and cancer have all substantially declined, the suicide rate has increased 28% since 1999. In the U.S., suicide is the 10th leading cause of death with an average of 129 suicides per day – the same rate as opiate overdoses and greater than both homicides and motor vehicle accidents. With the COVID-19 pandemic exacerbating existing risk factors for suicide, we anticipate that these numbers might rise. There is an increasing conviction internationally that suicide prevention is a core responsibility of health care and that effective suicide care should be embedded within health systems from screening to short term risk management and treatment, and long-term follow-up and surveillance. This conviction is the basis for the Zero Suicide initiative nationally and the Bree Collaborative’s Suicide Care Report and Recommendations here in Washington State.

University of Washington Department of Psychiatry and Behavioral Sciences faculty – from Harborview to Seattle Children’s Hospital to the VA Puget Sound – have been conducting research and developing interventions and policy to address suicide risk across the health system. In 2019, these faculty joined together to form the Center for Suicide Prevention and Recovery or CSPAR. CSPAR’s mission is to promote the recovery of individuals experiencing suicidal thoughts and behavior as well as the effectiveness and resilience of the clinical staff and families who care for them. CSPAR’s mission is achieved through rigorous and ecologically valid research; the development and adaptation of innovative interventions; collaboration with policy and government partners to improve policies, systems and environments of care; provision of expert training and consultation; and through listening to and understanding the lived experience of suicidality. As a center, we seek a deep understanding of the cultures and settings in which we work that leads to meaningful, pragmatic interventions that are ready for implementation.

Current CSPAR clinical trials research includes a large pragmatic randomized controlled trial of Preventing Addiction Related Suicide (PARS), a secondary prevention intervention developed by Richard Ries, MD; a four site randomized trial of Caring Contacts with American Indian and Alaska Native communities led by Kate Comtois, PhD, MPH, in collaboration with Lonnie Nelson, PhD, at Washington State University; and a research evaluation of the Caring Letters Program by Mark Reger, PhD, and the Veteran Crisis Line which is sending caring letters to 90,000 veterans a year and evaluating the impact. CSPAR research is investigating the opportunities of machine learning algorithms and natural language processing to enhance school safety, examine risk prediction of internet searches, and reaching Veterans at high risk of suicide. CSPAR is also involved in Dissemination and Implementation of suicide prevention interventions, particularly with the active duty military.

In addition to research, CSPAR faculty have been developing clinical programs and guidance to address suicide risk in health care. Molly Adrian, PhD, and Elizabeth McCauley, PhD, have implemented Clinical Care Pathways at Seattle Children’s to prevent the escalation of suicidal thoughts and behaviors as well as the new Seattle Children’s Behavioral Health Crisis Care Clinic. Dr. Reger and Larry Pruitt, PhD, at VA Puget Sound, have written timely guidance on the impact of COVID and strategies for suicide prevention care during COVID including suicide safety planning and the long-term impact on healthcare workers. Jeff Sung, MD, and Dr. Comtois collaborated on the Bree Collaborative Suicide Care Report and Recommendations for Washington State, and Dr. Sung also participated on the Bree Collaborative work group to address the 2016 Washington State Supreme Court decision Volk v. DeMeerleer through the Risk of Violence to Others.

These are just some of the ongoing and developing CSPAR projects and initiatives. To learn more, email any CSPAR faculty or staff or uwcspar@uw.edu any time. The team welcomes collaboration.