[Cooperation with primary care physicians on the issue of suicide prevention]

The "General Outline of Comprehensive Suicide Prevention Measures," formulated in 2007, places heavy emphasis on the role of primary care physicians (hereinafter "PC physicians") in preventing suicide, calling for improvements to their diagnostic and treatment capabilities, as well as for increased availability of appropriate psychiatric care. The following are study findings from Shimane Prefecture, Japan. 1. Among PC physicians, 38.4% had experienced the suicide of outpatients. For internists, the figure was 55.6%, while for physicians in other specialties it was 17%. 2. In the greater Matsue area, of the 948 new patients seen at psychiatric hospitals and clinics between June and August, 2009, 29.6% had been referred from PC physicians. Of the referred patients, 25.3% exhibited suicidal ideation (17.8% classified as mild, 5.7% as moderate, and 1.8% severe), while 12.5% had attempted suicide (6.4% classified as minor attempts, 3.9% as moderate, and 2.1% as serious). 3. In the greater Izumo area, although 73% of family doctors are treating patients with symptoms of depression, 38% of physicians noted the absence of specialists with whom they can consult. This highlights the need for greater availability of local psychiatric consultation services. 4. In the greater Masuda area, which had a very high suicide rate, a model suicide prevention project was implemented over two years, beginning in 2004. The project put great emphasis on cooperation between numerous concerned entities and organizations. Notable aspects of this project included cooperation between medical institutions and psychiatric hospitals, as well as efforts to promote the use of self check mental health assessments at the time of regular health checkups, after which persons with mental health issues were provided with support at the checkup site, as well as at medical and other facilities. Another element of the program consisted of the proactive implementation of home visits by public health nurses. These approaches are believed to have contributed to the decline seen in the suicide rate, from 48.9-58.1 per 100,000 population in 2001-2003, to 19.8-36.7 per 100,000 population in 2008-2010. 5. The findings of this study illustrate the fact that many PC physicians have experienced the suicide of outpatients, and endeavor to refer patients with mental health issues-including suicidal ideation and attempted suicide-to psychiatrists. Findings also show, however, that PC physicians are struggling due to a lack of psychiatric specialists available for consultation. Comprehensive measures to prevent suicide, including efforts by PC physicians and cooperation with psychiatrists, are effective. It is therefore necessary that plans for local medical services include cooperation between a wide variety of consulting organizations and medical services, as well as construction of a framework that organically links non-psychiatric medical institutions with departments of psychiatry.