Absolutely. At our last dinner in Latvia, I was talking to my colleague, my counterpart from the U.K. In a way, to understand as a physician, let's say you have somebody who has obesity, high cholesterol, and they smoke. They're coming into your office and you're going to give them the talk about watching their diet and stopping smoking, and then you'll give them a cholesterol medication. However, if they came in with chest pain and were sweating, you wouldn't keep talking to them about that. You'd probably switch and do an EKG and see if they're having a heart attack.
In the same way, you're working on prolonged exposure for PTSD or cognitive therapy for depression, but now they're declaring or you discover that suddenly this thing has happened. So let's shift. Let's talk about suicide. Let's talk about what it means. Let's develop ways, so when you're feeling hopeless, what can you do? Who can you call? It's that kind of idea.
Let's take some time to specifically work on suicidality. We're not going to ignore the underlying condition, because that's paramount, but in the meantime we're thinking about what we can do for people who are already in care who are contemplating, to keep them alive so we can actually treat the underlying condition.
In some ways, that sounds obvious, but it's only four or five years old. We have colleagues—I have a couple of teams—who are off to the U.S. to take some of the training, take part of it and consider whether we can bring it back here. One is the safety plan, which is specifically in Washington state; every primary care physician has to have this training. So when you have somebody who you're concerned about, it's not “Are you suicidal or not?” If they are, it's “What are you going to do if you feel that way?” It's a very concrete way of trying to focus on safety and then carry on with the treatment.
There are two different things: cognitive behavioural therapy specifically targeting suicidality as a thing, as an entity in itself; and this other safety plan. There are more and more different kinds of things, such as virtual hope boxes. Lots of different things are targeting suicidality itself. Just like if your cardiac risk patient is actually having a heart attack, let's save his life, resuscitate and fix him, so that then we can worry about the smoking and all those things.