Jill Kauer, PharmD, MS Phr, BCPP and Matthew Witry, PharmD, PhD
Suicide was the 10th leading cause of death in the United States in 2019. Although preliminary data indicate a 5.6% reduction in deaths from suicide during 2020,1 the long-term adverse effects of the COVID-19 pandemic on mental health and suicide rates remain to be seen. While the risk of suicide in the community and on college campuses is significant, suicide prevention training is not widely included in pharmacy education. Given that pharmacists are among the most accessible health care providers, and college can be a particularly stressful time for students, future pharmacists in all areas of pharmacy practice should be able to recognize warning signs that patients, colleagues, and close relations may be thinking about suicide and be comfortable asking about suicidal thoughts and plans. Survey data, however, indicate that most pharmacists feel they lack the training and skills needed to intervene when someone is considering suicide.2
Pharmacy educators have several considerations when choosing to implement suicide prevention training into the pharmacy curriculum, including training format, trainer availability, group size, and funding. At the University of Iowa, we considered two nationally recognized gatekeeper training programs: Question Persuade Refer (QPR) and Mental Health First Aid. Both training programs have an online format available, but we felt that students would be more engaged by in-person training. The shorter length of the in-person QPR program (90 minutes vs. 8 hours) allowed it to be more easily incorporated into a required, 6-week, team-taught integrative pharmacotherapy course on neurology and psychiatry which is delivered to second-year pharmacy students. This course has weekly small-group active learning time which is well-suited for such a training session. QPR has an option for faculty members to become certified trainers, but given the implementation timeframe, we engaged a local crisis center that offers QPR group training at a reasonable cost to provide training for our student pharmacists.
One of the logistical challenges we encountered with setting up the training is that the preferred group size for each QPR training session is 30 participants. In our curriculum, students are participating in pharmacy practice lab during the time that the other half of the class is participating in active learning for the integrated pharmacotherapy course. The coordinator of the pharmacy practice lab adjusted course meeting times and divided the class into three groups for lab and active learning activities for the day of the suicide prevention training, allowing for appropriate group sizes.
After creating a plan for incorporating the suicide prevention training program, the issue of funding was addressed. In the first year, the college paid for the training. In subsequent years, we have assessed a modest fee during course registration to cover training costs.
Evaluation data from pre- and post-participation surveys indicated that QPR training improved students’ confidence in their ability to engage in suicide prevention behaviors.3 Student feedback suggested that role-playing and tips on what to say when talking to someone about suicide were the most helpful elements of the training. We believe using a certified QPR trainer with years of suicide crisis intervention experience made the training especially relevant for our students. The trainer collaborated with the course coordinator ahead of time to understand when pharmacists might encounter patients with suicidal ideation in practice so that suggestions for how to manage these specific scenarios could be provided. We used a role-play between the trainer and the course coordinator to demonstrate how to discuss suicide with a patient. A number of students commented on the value of placing suicide intervention in the pharmacy context.
Tips for successful implementation of suicide prevention training into the pharmacy curriculum: