Dear Friends and Colleagues,

It’s a beautiful spring in Seattle, a late winter storm has replenished the snowpack in the Cascades, and some of us are making long overdue trips to see family, friends, and colleagues. I am looking forward to seeing many of you at one of our upcoming department events such as an evening to appreciate our volunteer clinical faculty on May 5, our annual meeting on June 15, our department graduation on June 24, or our department picnic sometime this summer.

This spring, we have had several opportunities that could make a big difference in increasing access to mental health care in our state, starting with a big win for kids’ mental health in Washington. During the last legislative session, the Washington State Legislature passed and funded nearly all the recommendations of the Children & Youth Behavioral Health Work Group including the development of a Strategic Plan for Kids’ Mental Health to build a coherent system of care. Thanks to all of you who had a role in advocating for these much-needed programs.

We also had an opportunity to influence mental health care on a national level. Anna Ratzliff testified to the US Senate Committee on Finance about opportunities for Congress to improve access to effective mental health care such as the integration of behavioral healthcare into primary care, addressing health equity, and increasing access to telehealth.

We are pleased to see the ongoing success of our efforts in Global Mental Health. Over the past few years, mental illness and addiction have become increasingly recognized as leading causes of health-related disability worldwide, and we have much to learn from our colleagues around the world about different ways to address the suffering and the stigma experienced by those living with mental health and addiction problems. Speaking of work on the global stage, Eric Bruns, PhD, recently joined colleagues on a Health Support Team working in Poland to teach volunteers basic skills to respond to the mental health needs of children forced from their communities by the war in Ukraine. Pamela Y. Collins, MD, MPH, has been mobilizing the UW community to support her I-TECH colleagues in Ukraine including finding therapists and psychologists who can connect with the team by phone, email, text or zoom.

Closer to home, we funded nine fantastic projects related to suicide prevention and recovery with support from a wonderful gift from the Mary. E Nelson Charitable Remainder Trust, Heidi Combs Trustee and secured pilot funding from ITHS and the UW Population Health Initiative. These internally-funded pilot projects are wonderful complements to the amazing portfolio of federal and foundation grants we have thanks to the 100+ researchers in our department.

We also welcomed an amazing new class of psychiatry residents who will join us this summer. Later this spring, we will announce a new effort to bring together our strengths in training and in research, supporting a new program to develop clinician scientists in our department. Stay tuned for more information about this effort at our upcoming annual meeting on June 15.

Speaking of the intersection of clinical work and research, I was recently asked by a group of trainees about the role of science and research evidence in our clinical work. I reflected on the diverse insights and paradigms from neuroscience to psychological and social sciences that shape our explanations of what constitutes and causes mental illness and our diagnostic and therapeutic approaches. These diverse paradigms and their proponents have at times competed fiercely, drawn vocal criticism from inside and outside our field, and they can make it challenging for us to have a coherent narrative about our work. For some, these competing explanatory models are evidence that we do not know what we are talking about, or that we are practicing a pseudoscience that attempts to ‘medicalize’ normal human emotions and phenomena for profit or other dubious motives. I see this diversity of approaches as a strength, reflecting the complexity of our discipline, and making psychiatry one of the most interesting, challenging, and rewarding fields for a new clinician to pursue. I believe that the vigorous debate between competing paradigms in our field has created and honed a powerful set of tools that we can put to work today while we look for better treatments tomorrow. In our clinical work, we work to understand how our patients’ lives are shaped by their unique biology, social circumstances and life experiences. We aim to do more than simply control unwelcome emotions and behaviors, but to help our patients overcome barriers and pursue their dreams. We draw on the evidence from state-of-the-art research, our own clinical experience, and crucial evidence from our patients’ own lived experiences. Sometimes the most important insights do not emerge until initial efforts at diagnosis and treatment have missed the mark and it is wise for us to stay humble, to keep a close eye on our patients’ response to treatment, and to remain open to changing our approach if patients do not improve as expected. Speaking of keeping an open mind, we had an outstanding turnout at a recent symposium that focused on developing novel therapeutics in addiction medicine. Thanks to Nathan Sacket, MD, MS, and to our department staff for organizing this amazing event! 

We also continue the important work to become a more diverse, inclusive, and antiracist department. We are making progress, but it is clear that we are not immune from the biases and the systemic racism that can contribute to the stigmatization and oppression of vulnerable groups. At our upcoming faculty teaching retreat on April 27, we will be joined by Dr. Danielle Hairston from Howard University to talk about practices that undermine diversity, equity and inclusion and about ways to develop robust anti-bias and anti-racism approaches. 

I want to end on a note of gratitude to all of you and especially to Dr. Michael V. Vitiello who is retiring this month after over 40 years in our department. We look forward to honoring Michael and the other faculty and staff who retired over the course of the pandemic at our annual meeting this June.

Jürgen

Evaluation of A New Approach to Youth Suicidal Crises: Swift Outpatient Alternatives for Rapid Stabilization (SOARS). Molly Adrian, PhD, Eileen Twohy PhD, and Elizabeth McCauley, PhD,will evaluate a novel program developed by our team to improve the effective outpatient management of youth with acute suicide risk. This program evaluation examines just-in time intervention to assess suicide risk level, address imminent risk, and begin treatment to address ideographic suicidal drivers over time. The clinic has served over 200 youth and families since 2019. Qualitative and quantitative data from youth, caregivers, and clinicians demonstrate high levels of fidelity, feasibility, appropriateness, and acceptability, however, impact on core health outcomes has not been conducted. This funding will allow for analysis of the treatment program to demonstrate the impact of the intervention on suicidal thoughts and behaviors.
 
Consumer Perspectives of Online & In-Person Suicide Prevention Strategies
Patricia Areán, PhD, and Kate Comtois, PhD, will explore which interventions people with lived experience of suicide find acceptable (e.g., different types of in-person and telehealth care, web-based, text message, app, etc.), who should be the agent to deliver the intervention, and what concerns would they have in having social media and search data used for risk identification and then intervention. These findings have the potential to impact how suicide prevention strategies are brought to scale in a way that is seen as acceptable and appropriate to patients at risk for suicide
 
Using routine alcohol screening measures to identify 1-year risk of suicidal ideation, intent,
and planning within a large primary care system in Washington
Yanni Chang, MD, MPH, Kevin Hallgren, PhD, Julie Richards, PhD, MPH, and Katharine Bradley, MD, MPH, will conduct a study using a large population-based primary care sample in Washington state to understand how heavy alcohol use and alcohol use disorder symptoms contribute to suicidal thoughts. This study will allow examination of how different levels of alcohol use can predict short term risk of suicidality and allow us to better identify and support patients at risk of suicide in the primary care setting.
 
Suicide Risk Screening in Acute and Intensive Care at a Level 1 Trauma Center
Patients hospitalized for medical, surgical, or traumatic injury reasons at Harborview Medical Center are universally screened for suicide risk. The present research will advance knowledge about the practices occurring at this large healthcare institution serving the public and social safety net population and set the groundwork necessary for conducting future research designed to improve services not only at Harborview but at similar institutions across the U.S. A team led by Doyanne Darnell, PhD, and Imara West (Research Scientist at Data Quest) will capture population-level electronic health record (EHR) data on suicide screening rates and outcomes among medically hospitalized patients for a 1-year period and gain insight into the context of the data captured through focus groups with acute/intensive care nurses.
 
Developing a Resource Toolkit for Clinician Survivors of Suicide Loss
Amanda Focht MD, Jeff Sung MD, and Katherine Anne Comtois PhD, MPH, will develop a resource toolkit for clinician survivors of suicide loss. For clinicians, the death of a patient by suicide is a dreaded event and can be more distressing than death and dying encountered in other clinical situations. In response to patient suicide, some clinician survivors experience emotional and psychological distress that may reach clinical levels and negative and sometimes persisting effects on professional practice. Building on existing reference materials, we will develop a toolkit of resources to guide and support faculty, clinical staff and trainee clinician-survivors affiliated with the department hospitals. These resources would address educational, emotional, administrative and spiritual needs of clinician-survivors.

Role of Criminal Defense Attorneys in Suicide Prevention Following Defendant Arrest
Jennifer Piel, MD, JD, Joellyn Sheehy, MD and colleagues at the Washington Defenders Association and Washington State Bar Association will explore the role that criminal defense attorneys could play in reducing risk of suicide amongst recently arrested criminal defendants. Suicide is the leading cause of death in jails and the period after recent arrest may be a particularly vulnerable time for suicide. For many persons with recent arrest, their attorney is one of only a small number of persons that they encounter in the days following arrest. This proposal aims to better understand the experience of the criminal defense attorney in working with clients who have suicidal thinking or behavior; training they have received in the past; desired training (such as suicide risk identification, trauma-informed care, resources); and challenges in disclosures in light of their professional responsibility to preserve client confidences. 

Understanding the Support Needs of Gender Expansive Youth
Approximately 35% of youth who identified as transgender report having attempted suicide in the past 12 months. Despite this high risk, few preventive interventions have been developed specifically to address the unique needs of this group who experience high rates of marginalization, victimization and social isolation based on their gender identities. Laura Richardson, MD, MPH, and Katherine Anne Comtois, PhD, MPH will use human centered design principles to adapt the Caring Contacts intervention for suicide prevention for transgender and gender expansive (TGE) youth and user test this intervention with suicidal ideation who are identified via a Zero Suicide-based screening program in the Seattle Children's Gender Clinic.

Impact of the Preventing Addiction-Related Suicide (PARS) Intervention on patients who receive community-based addiction treatment
Persons with substance use disorders are 5-10 times more likely to die by suicide than the general public. Recognizing this, Rick Ries, MD, Katherine (Kate) Comtois, PhD, and the UW Center for Suicide Prevention and Recovery (CSPAR) staff developed the first and only suicide prevention intervention successfully developed with and tested in community addiction treatment centers. The primary outcomes of the multisite PARS clinical published in JAMA Network Open in April 2022. Led by Dr. Ries, Kevin Hallgren, PhD, Amanda Kerbrat, LICSW, and Yanni Chang, MD, this project will fund a more detailed secondary analyses to better characterize which patients respond best to the PARS intervention, which in turn will help inform intervention improvements.
 
WA State Parent Network to Prevent Youth Suicide and Improve Student Mental Health
Rates of suicide and mental health challenges among youth have never been higher. An essential part of youth well-being, mental health and suicide prevention is that parents and other caregivers of youth are prepared to support their children in these challenging times. Asking IS Caring is a parent-caregiver network started in Eastern Washington to provide community education, peer to peer support to families struggling with youth suicide behavior/ death, and input to districts implementing mental health programming and supports. Led by Jennifer Stuber, PhD, Kelcey Schmitz, MSEd, and Eric Bruns, PhD, this grant will help put into place essential infrastructure to further develop and to sustain the parent-caregiver network as well as to evaluate programming stemming from the network's activities. Asking Is Caring is supported by a curriculum designed to offer parents-caregivers an invitation to be present with their child. It offers opportunities for participants to problem solve, and questions they can ask of their child, the parent’s friends, and of themselves. Asking IS Caring provides practical steps to build protection from suicide in the home.