November 16, 2017

David Yamashita said his mother was his hero and his continued source of inspiration. But no one in the family knew how dark her moods were until she took her own life by taking a bottle of prescription medicine.

“We never thought in a million years she would take her own life,” said Yamashita, a community advocate for Forefront, a suicide prevention center based out of the University of Washington School of Social Work. “Suicide was never on our radar.”

Yamashita’s story is one of the personal video stories in a suicide-prevention training called “All Patients Safe.”

As of July 1, all healthcare providers in Washington state are required to take an approved suicide-prevention course as part of their continuing education requirements.  This includes therapists, counselors, social workers, chiropractors, naturopaths, physicians, physical therapists, pharmacists, nurses, physician assistants and osteopathic physicians, surgeons and physician assistants.

The law is known as the Matt Adler Suicide Assessment, Treatment and Management Act of 2012.

Washington is the first state to require such training.

“The law recognizes the key role medical professionals play in addressing the silent epidemic of suicide,” said Jennifer Stuber, policy director of Forefront and an associate professor of social work at the University of Washington. She was the driving force behind the new law. Matt Adler was her late husband. She said most people who die by suicide don’t see a mental health counselor but commonly interact with healthcare providers in the weeks leading up to their suicide.

All Patients Safe is unique because it features real stories of individuals affected by suicide and it was designed by medical professionals for medical professionals. It contains practical information about medication and firearms safety that can be incorporated into every patient interaction.

“We wanted to make it as impactful as possible,” said Anna Ratzliff, associate professor of psychiatry and behavioral sciences in the UW School of Medicine and one of the physicians who helped create the case-based training module.

Along with addressing suicide risk, assessment, management and treatment among adults and veterans as required by state law, the All Patients Safe training teaches these skills for providers working with youth and woman who are perinatal—three months before birth and one month after.

“This training changes suicide prevention across the U.S. by sharing personal stories targeted specifically to health care providers, many of whom work in rural medical settings where the suicide rates are the highest,” said Vikram Jandhyala, executive director of CoMotion, a collaboration innovation hub at UW. CoMotion provided an innovation grant to develop the training.

Other collaborators include the School of Nursing, the Departments of Family Medicine and Psychiatry and Behavioral Sciences, Seattle Children’s and the VA Puget Sound Healthcare System.

In Washington state, more people die by suicide than by traffic fatalities, breast cancer or prostate cancer. The state is ranked No. 22 when it comes to suicide rates. Middle-aged men, Native Americans and Alaska Natives, transsexuals and veterans of the U.S. armed forces are the highest at-risk groups. And suicide is the second leading cause of death among Washington’s young people aged 10 to 24.

NOTE: In 2018, the All Patients Safe team will provide consultation to health care systems updating their protocols to align with the suicide prevention training of their health care professionals. To learn more, contact

By Bobbi Nodell, UW Medicine