Suicide remains one of the most pressing public health challenges in the United States. Over the past decade, suicide rates have risen alarmingly, leaving families and communities grappling with the devastating consequences of loss. Even more troubling is the evidence showing that nearly half of individuals who die by suicide visit a primary care provider within a month of their death (Luoma, Martin, & Pearson, 2002). This data underscores the critical opportunity to identify and support at-risk individuals within the primary care setting. Unfortunately, traditional approaches to suicide prevention—such as referrals to emergency departments or specialized mental health services—often fail to provide the timely, consistent care needed to reduce risk (Little & White, 2022). Many individuals never attend follow-up appointments, leaving their needs unaddressed.
This gap in care calls for innovative, evidence-based models like the Collaborative Care Model (CoCM), which integrates behavioral health support directly into primary care settings. CoCM provides an accessible, sustainable framework for delivering comprehensive care to individuals at risk for suicide. It ensures that patients can receive the mental health support they need within the trusted environment of their primary care provider’s office.
The Collaborative Care Model: Evidence-Based and Patient-Centered
The Collaborative Care Model is a proven approach to identifying and treating behavioral health conditions, including depression, anxiety, and suicide risk. Developed by the AIMS Center at the University of Washington, CoCM is supported by more than 100 randomized controlled trials, making it one of the most rigorously validated frameworks in behavioral health care. At its core, the model emphasizes a team-based, measurement-driven approach that facilitates close coordination between primary care providers, behavioral health care managers, and psychiatric consultants.
At Concert Health, CoCM is implemented using a range of tools, including the Patient Health Questionnaire (PHQ-9), a widely used screening instrument for depression that also helps detect suicide risk. For individuals scoring high on self-harm indicators, further assessment is conducted using tools like the Columbia Suicide Severity Rating Scale (C-SSRS) or the Ask Suicide Screening Questions (ASQ). These tools enable early identification of suicide risk, ensuring that patients receive the appropriate level of care promptly and within a familiar environment.
Personalized Engagement and Flexible Care Plans
One of the key strengths of CoCM is its ability to provide consistent, personalized engagement with patients. High-risk individuals receive frequent follow-ups and support, including access to psychiatric consultations within the first week of care. This rapid response can be life-saving, as it addresses the urgent needs of individuals who might otherwise face lengthy wait times in traditional mental health systems. For patients with lower levels of risk, CoCM offers flexible, dynamic care plans that evolve over time, ensuring that interventions are tailored to meet individual needs.
For instance, a patient who initially presents with moderate risk may benefit from bi-weekly check-ins with a behavioral health care manager. If their symptoms escalate, the care plan can be adjusted to include more frequent contact or additional psychiatric support. This adaptability is crucial for addressing the complex and often fluctuating nature of behavioral health conditions.
Outcomes That Save Lives
The impact of Concert Health’s Collaborative Care services is evident in the outcomes achieved. Among patients identified as at risk for suicide, 76% who engaged in six months or more of CoCM care demonstrated significant reductions in their risk levels (Little et al., 2024). Additionally, over 2,100 patients successfully transitioned to safer risk levels during their care episodes.
In total, approximately 15% of patients in Concert Health’s care are flagged for suicide risk, and 40% of these individuals show measurable improvements by the time they are discharged. These statistics highlight the life-saving potential of CoCM and its ability to deliver meaningful results for individuals and families.
Scalable and Sustainable Solutions
CoCM is not only effective but also highly scalable. Recognized as a reimbursable benefit by Medicare, Medicaid, and most commercial insurance plans, it has the potential to transform behavioral health care delivery on a national scale. Concert Health’s ability to provide both virtual and in-person services further enhances its accessibility, particularly for underserved or rural populations where traditional mental health resources may be limited. This flexibility ensures continuity of care, regardless of geographic or logistical barriers.
Building Resilience Beyond Immediate Risk
While CoCM excels in addressing immediate suicide risk, its long-term benefits are equally noteworthy. By incorporating safety planning and ongoing engagement into the care process, the model fosters resilience and stability for patients over time. High-risk individuals benefit from weekly interactions with care managers and regular psychiatric consultations, creating a robust support system that reduces the likelihood of future crises. Meanwhile, patients with lower levels of risk receive continuous monitoring and tailored interventions, ensuring that their recovery is supported at every stage.
This sustained engagement not only improves patient outcomes but also strengthens the relationships between individuals and their primary care providers. By addressing behavioral health needs within the primary care setting, CoCM breaks down barriers to mental health care and empowers families to navigate complex emotional challenges with confidence and support.
Transforming the Future of Suicide Prevention
As more health systems adopt the Collaborative Care Model, the potential to improve suicide prevention efforts becomes exponential. By integrating behavioral health into primary care, CoCM offers a proactive, patient-centered approach that fosters trust, accessibility, and hope. It not only saves lives but also provides individuals, families, and communities with the tools they need to heal and thrive.
Virna Little, PsyD, LCSW-r, MBA, CCM, SAP, is Co-founder, and Jian Joyner, LSW, is Research Assistant at Concert Health. For more information about Concert Health and its suicide prevention efforts through the Collaborative Care Model, visit concerthealth.com or contact Dr. Virna Little at virna@concerthealth.io.
References
Little, V., & White, C. (2022). Collaborative Care as an effective intervention for primary care patients at risk for suicide. Journal of Health Care for the Poor and Underserved, 33(3), x-xii. https://doi.org/10.1353/hpu.2022.0098
Little, V., Hardy, C., Green, B., & Fuller, S. (2024). Addressing suicide risk: A study of dose response in Collaborative Care. JG Research and Evaluation, Concert Health, and the Bowman Family Foundation.
Luoma, J. B., Martin, C. E., & Pearson, J. L. (2002). Contact with mental health and primary care providers before suicide: A review of the evidence. The American Journal of Psychiatry, 159(6), 909-916. https://doi.org/10.1176/appi.ajp.159.6.909
