A Week of SAMHSA-funded Suicide Prevention Innovation at VCOM

Thanks to a 3-year suicide prevention grant from SAMHSA, this week marked a milestone in suicide prevention training for medical education. At the Edward Via College of Osteopathic Medicine (VCOM) in Spartanburg, South Carolina, we brought together national experts, physicians, clinical psychologists, and medical students to create immersive, simulation based modules that will transform how medical schools address mental health and suicide prevention.

The crisis facing medical students is well-documented. Research indicates that approximately one in ten medical students report suicidal thoughts during their training, with rates of depression significantly higher than age-matched peers (Rotenstein et al., 2016). The unique pressures of medical education—academic rigor, clinical exposure to trauma, and a climate of perfectionism—create perfect conditions for mental health crises. Most importantly, stigma relating to getting treatment for mental health poses a serious barrier for medical students and physicians (Berliant et al., 2022).

Over two intensive days, we captured expert interviews and realistic clinical scenarios for the Sharpen DTX platform's professional training series. Dr. Alex Karydi, a suicidologist from the Education Development Center (EDC) and Zero Suicide initiative, led expert panels covering evidence-based suicide screening, collaborative safety planning, crisis intervention protocols, and postvention strategies that prevent contagion while supporting healing communities.

Adapting the Zero Suicide Framework

Our approach to medical student suicide prevention at VCOM is grounded in the evidence-based Zero Suicide framework, a systems-level model that has demonstrated remarkable success in healthcare settings. Originally developed by Henry Ford Health System, the Zero Suicide model achieved a 75% reduction in patient suicides through systematic screening, enhanced care pathways, and comprehensive safety planning (Ahmedani et al., 2025; Hampton, 2010; Smith et al., 2013). Recent large-scale implementation research across six health systems found significant reductions in suicide attempt rates in outpatient mental health care, with sustained effectiveness when the model's seven core elements—lead, train, identify, engage, treat, transition, and improve—are fully integrated (Ahmedani et al., 2025; Education Development Center, 2016). For our medical student population, we are adapting this framework to address the unique cultural barriers to help-seeking in academic medicine, where students face suicide rates three times higher than their same-age peers (American Association of Medical Colleges, 2022; Goebert et al., 2009). Through the Sharpen DTX platform, we're implementing upstream training that normalizes daily conversations about risk and protective factors, moving beyond individual clinician efforts to create systemic accountability and institutional support for prevention. This paradigm shift from reactive responses to proactive, evidence-based intervention directly addresses both clinical care delivery and the systemic factors affecting medical students' wellbeing (Makhija et al., 2025; Dyrbye et al., 2017).

We integrated multiple perspectives by filming medical students sharing their lived experiences with shame cycles, impostor syndrome, and fears of professional consequences for seeking help. Faculty members candidly discussed how to create cultures of psychological safety while maintaining academic rigor. Physicians and residents provided frontline perspectives on the practical tools they need to recognize warning signs and intervene effectively with struggling colleagues.

https://vimeo.com/1155589793

Suicidologist, Dr. Alex Karydi along with physicians, medical students and clinical psychologists filming at VCOM.

The scenarios we create will be available to medical students, faculty, physicians and residents so they have reference scripts to use in the trenches directly through Sharpen DTX. Research demonstrates that gatekeeper training programs can significantly increase knowledge, self-efficacy, and intervention likelihood when recognizing warning signs (Isaac et al., 2009). Our program directly tackles the perfectionism, fear of professional consequences, and disconnection that research identifies as key risk factors in medical populations (Dyrbye et al., 2006). Other Sharpen suicide prevention training programs that were used as the foundation for this initiative have shown to increase competence and confidence in addressing suicide (Rios et al., 2024; Hussa Farrell, 2024), and improving mental health literacy and suicide prevention best practices (Berreta et al., 2023; Biber, 2023).

This project represents a three-year SAMHSA-funded commitment to transform suicide prevention at VCOM, with impact extending far beyond one institution. By integrating these evidence-based training modules into Sharpen DTX, we're creating scalable tools for health systems and medical schools nationwide.

References:

Ahmedani, B. K., Penfold, R. B., Frank, C., Richards, J. E., Stewart, C., Boggs, J. M., Coleman, K. J., Sterling, S., Yarborough, B. J. H., Clarke, G., Schoenbaum, M., Aguirre-Miyamoto, E. M., Barton, L. J., Yeh, H. H., Westphal, J., McDonald, S., Beck, A., Beidas, R. S., Richardson, L., Ryan, J. M., … Simon, G. E. (2025). Zero Suicide Model Implementation and Suicide Attempt Rates in Outpatient Mental Health Care. JAMA network open, 8(4), e253721. https://doi.org/10.1001/jamanetworkopen.2025.3721

American Association of Medical Colleges. (2022). Healing the very youngest healers. AAMC News. https://www.aamc.org/news/healing-very-youngest-healers

Berreta, K., Nguyen, C., Stoner, A. M., Ridgeway, L., Wilson, A., Fadel, N., & Biber, D. (2023). A RE-AIM Analysis of a Mental Health App for Undergraduate and Medical Students during the COVID-19 Pandemic: A Retrospective Cross-Sectional Study. International journal of environmental research and public health, 20(13), 6266.

Berliant, M., Rahman, N., Mattice, C., Bhatt, C., & Haykal, K. A. (2022). -Barriers faced by medical students in seeking mental healthcare: A scoping review. MedEdPublish (2016), 12, 70. https://doi.org/10.12688/mep.19115.1

Biber, D. (2023). The Impact of an mHealth Mental Health Literacy Training for Foster Parents Prepared for Trends in Psychology. Trends in Psychol. (2023). https://doi.org/10.1007/s43076-023-00348-x

Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Academic medicine : journal of the Association of American Medical Colleges, 81(4), 354–373. https://doi.org/10.1097/00001888-200604000-00009

Dyrbye, L. N., West, C. P., Sinsky, C. A., Goeders, L. E., Satele, D. V., & Shanafelt, T. D. (2017). Medical Licensure Questions and Physician Reluctance to Seek Care for Mental Health Conditions. Mayo Clinic proceedings, 92(10), 1486–1493. https://doi.org/10.1016/j.mayocp.2017.06.020

Education Development Center. (2016). Zero Suicide toolkit. Suicide Prevention Resource Center. https://zerosuicide.edc.org/toolkit

Goebert, D., Thompson, D., Takeshita, J., Beach, C., Bryson, P., Ephgrave, K., Kent, A., Kunkel, M., Schechter, J., & Tate, J. (2009). Depressive symptoms in medical students and residents: a multischool study. Academic medicine : journal of the Association of American Medical Colleges, 84(2), 236–241. https://doi.org/10.1097/ACM.0b013e31819391bb

Hampton T. (2010). Depression care effort brings dramatic drop in large HMO population's suicide rate. JAMA, 303(19), 1903–1905. https://doi.org/10.1001/jama.2010.595

Hussa Farrell, R. (2024). The founder of the Sharpen system spent 20 years as a public health educator, bringing primary prevention programs into schools and communities. During this time she captured over 50,000 post program surveys and documented the 150 most commonly asked questions during Q&A sessions with clinical psychologists, patients with lived expertise and with researchers. More than 4,000 individuals came forward to seek treatment after these sessions. This data was important fundamental groundwork for building the Sharpen system in 2014.

Isaac, M., Elias, B., Katz, L. Y., Belik, S. L., Deane, F. P., Enns, M. W., Sareen, J., & Swampy Cree Suicide Prevention Team (2009). Gatekeeper training as a preventative intervention for suicide: a systematic review. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 54(4), 260–268. https://doi.org/10.1177/070674370905400407

Makhija, H., Davidson, J., Lee, K., Barnes, A., Choflet, A., Zisook, S. (2025). National Incidence of Physician Suicide and Associated Features. JAMA Psychiatry, 82(5):451–458. doi:10.1001/jamapsychiatry.2024.4816

Rios, I., Biber, D. (2024).  Sharpen Health Care Worker app data.  Sharpen data were gathered from de-identified pre- and post- test surveys incorporating OMS-HC, and user acceptability and training feedback metrics.  Ongoing evaluation is in process, led by Ileah Rios, MPH and Duke Biber, PhD with anticipated publication of findings in 2026-2027.

Rotenstein, L. S., Ramos, M. A., Torre, M., Segal, J. B., Peluso, M. J., Guille, C., Sen, S., & Mata, D. A. (2016). Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA, 316(21), 2214–2236. https://doi.org/10.1001/jama.2016.17324

Smith, E. G., Kim, H. M., Ganoczy, D., Stano, C., Pfeiffer, P. N., & Valenstein, M. (2013). Suicide risk assessment received prior to suicide death by Veterans Health Administration patients with a history of depression. The Journal of clinical psychiatry, 74(3), 226–232. https://doi.org/10.4088/JCP.12m07853