Kashiwa talks suicide preventionAmy Kashiwa, OTD, OTR/L, is a graduate of the Doctor of Occupational Therapy (OTD) program at Rocky Mountain University of Health Professions (RMUoHP). While in the OTD program, Kashiwa focused her capstone project on occupational therapy and suicide prevention, particulary with veterans. Her work culminated in an article published in the American Journal of Occupational Therapy, “Occupational Therapy and Veteran Suicide: A Call to Action.” She continues to be an advocate of suicide awareness and prevention training among healthcare professionals.

Suicide Awareness with Veteran Populations

Veteran populations are especially effected by suicide, due to a variety of reasons. “90% of people who die by suicide have a diagnosable mental health condition,” explained Kashiwa. The veteran population may be dealing with a higher level of mental health conditions or suicide risk factors, such as post-traumatic stress disorder (PTSD), depression, anxiety, and substance use. Other risk factors include being trained and having access to lethal weapons, struggles of transitioning from military routine to civilian life, changes in relationships or occupation. “All of those things can create a perfect storm for suicide to happen,” said Kashiwa. 

COVID-19’s Impact on Suicide Risk and Awareness

Since the outbreak of COVID-19, some national suicide prevention call centers had a 300% rise in calls (Sweeney, 2020). Kashiwa said that many of the calls are triggered by feelings of isolation and anxiety; “they are reaching out for support.” But there have been positives too. “Throughout the pandemic, there has been a lot of news coverage about mental health. The more we talk about mental health and feeling stress, the less stigma there will be about mental health,” said Kashiwa.

“One of the struggles of people who contemplate suicide is the actual stigma to reach out for help. Oftentimes they’re dealing with mental health conditions,” said Kashiwa. “I think one silver lining in the current pandemic is that now we’re talking about mental health more than we ever were before.”

Raising Awareness on Suicide Prevention

Kashiwa hopes to increase awareness around suicide prevention legislation. Her home state of Washington has one of the most comprehensive legislation-mandated suicide prevention trainings in the healthcare professions field. Since 2014, all occupational therapists and occupational therapy assistants are required to have three hours of suicide prevention training every six years. That same legislation requires physicians, physician assistants, nurses, chiropractors, dentists, dental assistants, pharmacists, physical therapists, physical therapy assistants, social workers, and mental health workers to also have suicide prevention training. “It’s a comprehensive legislation that keeps getting more refined and added on to,” said Kashiwa. The state just passed legislation mandating that veterinarians and veterinary assistants are now required to have suicide prevention training as well.

But Washington is one of the few. “Currently there are only three states that mandate suicide prevention training for occupational therapists. Three is not enough,” said Kashiwa. “Education is important especially because suicide is preventable.”  

Barriers to Suicide Prevention among Healthcare Professions

There are many barriers to healthcare professionals getting appropriate suicide prevention training. Lack of legislation on a state level is just one of those barriers. Geography is another barrier. “People in rural communities have less access to health care,” explained Kashiwa.

Other barriers include lack of suicide prevention training and lack of competence to address suicide in clinical practice. 

Kashiwa explains that suicide prevention trainings often delve into personal bias or stigmas toward suicide or mental health in general. “Are we comfortable asking someone if they have a  suicide plan or are thinking about suicide?” Training and practicing those questions and situations make it easier because “when you’re in a situation where you need to ask the question, you’ve said it before and know what it feels like,” said Kashiwa. 

Promoting Suicide Prevention among Healthcare Professionals

“Suicide doesn’t discriminate, said Kashiwa. “It crosses all cultures and all age groups, though certain populations and age ranges have higher rates of suicides. As healthcare providers we need to be aware that we will potentially come in contact with someone who is suicidal at some point in our career regardless of the practice or setting that we work in.”

There are many resources related to suicide prevention. The Suicide Prevention Resource Center provides information and trainings, as well as legislation regarding suicide prevention broken down by state. 

“Culturally, we don’t like to talk about suicide. So people don’t talk about mental health as much as we should. How we talk about suicide is also important. ‘Committed suicide’ has a negative connotation, like committing a crime. ‘Died by suicide’ is a more appropriate way to talk about it,” said Kashiwa. “The more we talk about it and the more information we have, the better equipped we are to handle it.”

Listen to the entire RMUpload episode here


Additional Resources

Forefront Suicide Prevention (University of Washington)

Suicide Prevention Resource Center

National Suicide Prevention Lifeline

National Suicide Prevention Lifeline at 800 273-8255 or text the Crisis Text Line at 741741



American Foundation for Suicide Prevention. (2019). State laws: Training for health professionals in suicide assessment, treatment, and management. Retrieved from https://afsp.org/wp-content/uploads/2019/06/AFSP_HealthProfessionalTrainingIssueBrief_6-7-19.pdf

Kashiwa, A., Sweetman, M. M., & Helgeson, L. (2017). Centennial Topics– Occupational therapy and veteran suicide: A call to action. American Journal of Occupational Therapy, 71(5), 7105100010p1-7105100010p6

Matt Adler Suicide Assessment, Treatment, and Management Act, Wash. Stat. Ann. §§ 249 (2012; E.S.H.B. 1424, 2015).

Sweeney, D. (2020, March 25). Some areas of the country see increase in suicide-related calls as Coronavirus spreads. Sacramento Bee. Retrieved from: https://www.sacbee.com/news/coronavirus/article241493126.html

Washington State Department of Health (2019). Suicide prevention training for health professionals. [2019 Model list]. Retrieved from https://www.doh.wa.gov/ForPublicHealthandHealthcareProviders/HealthcareProfessionsandFacilities/SuicidePrevention/TrainingPrograms/ModelList