SALT LAKE CITY — Though she is just recently removed from her formative years, the plague of suicide has already intruded into Skye Karlinsey's life multiple times.
"When I graduated high school in 2016, I left with two fewer friends alive than when I started," Karlinsey, a social work student at Weber State University, told lawmakers Thursday. "Both were victims of their own mental illness."
Moved by her own friends' untimely deaths, Karlinsey was at Capitol Hill to testify on a bill she believes will help more young people find better and faster relief for their mental health crises by including suicide prevention training among the preconditions for obtaining or renewing any doctor's license in Utah.
"(Youth suicide) deaths are tragic, impactful and, most importantly, entirely preventable," Karlinsey told the House Business and Labor Committee. "The medical professionals protecting our children in times of crisis should be overtrained and overqualified when it comes to preventing youth suicides. For now, we at least should provide adequate levels of training."
HB87, the bill putting that training in statute, was recommended favorably by the committee Thursday by a unanimous vote. It will next go to the full House of Representatives for consideration.
The bill states that doctors shall undergo "a minimum of two hours of training in suicide prevention via a course" approved by the Division of Professional Licensing in order to both obtain their medical license and renew it every two years.
The bill's sponsor, Rep. Justin Fawson, R-North Ogden, called it a critical step in ensuring that the entirety of the state's medical community operates with at least a basic knowledge of how to best help their patients who experience mental health crises, noting that "80 percent of our physicians self-profess to have no training in suicide prevention."
"This is a problem at the training level, at the system level," Fawson said of Utah's high suicide rate, a figure that ranks fifth in the country, according to the latest Centers for Disease Control and Prevention data. "This (bill) is one of those solutions to help fill those gaps."
However, in a change from earlier versions due to health industry pushback, the bill allows the Division of Professional Licensing to "issue a waiver from the requirement" to doctors who request one, which Fawson lamented as "not ideal."
The division is "still working out the details of how that opt-out would work," he said. "Frankly, I think what they have is really, really easy and maybe too easy."
Fawson was responding to a question from Rep. Travis Seegmiller, R-St. George, who worried about the same loophole, saying, "I just want to make sure that (the bill) really can accomplish what you want it to."
Like Karlinsey, Seegmiller said his life has been directly touched by the tragedy of suicide, having lost a family member to it.
"My oldest nephew … is one of the statistics … from the end of 2017," Seegmiller said. "So this hits home really close and personal to me."
Medical groups' concerns
Michelle McOmber, CEO of the Utah Medical Association, told the committee she would like to see amendments to HB87 on the House floor to widen the scope of providers in a primary care setting subjected to the requirement.
McOmber also said she would like to see exemptions made for physicians with limited to no patient interaction or for whom the requirement would not apply for other reasons, including pathologists, anesthesiologists and neurosurgeons.
McOmber said her organization's own inquiry with doctors found that the vast majority of them "actually said they are very well-trained in this area."
She said she received feedback from at least some doctors that putting "more burdens like this on physicians … actually increases the risk of physician suicide."
"Place too many extra burdens on physicians, and you actually increase their (own suicide risk)" is the sentiment that some doctors expressed, she said.
Despite those concerns, McComber said, the Utah Medical Association is not formally opposing HB87.
Jennifer Dailey-Provost, executive director of the Utah Academy of Family Physicians, said she's concerned "a precedent" could set with the bill, eventually leading to a large list of health problems best suited to one speciality becoming a required training for all doctors in Utah.
"If we have required training for suicide risk, then who's to say cardiologists won't come out and say we have to have mandatory training for hypertension or endocrinologists insisting that we have mandatory training for diabetes," Dailey-Provost said.
Dailey-Provost also said that "every family physician who's licensed does suicide prevention training. It's part of residency." She said many such doctors are engaged in ongoing training that would qualify under the bill, that most family physicians will not opt out of training anyway, and that her organization isn't formally opposing it.
'One more piece of the puzzle'
Taryn Hiatt, the area director overseeing Utah and Nevada for the American Foundation for Suicide Prevention, said HB87 could make a significant impact on people turning to their family doctor for help and is an important intermediate step "until that day … we get more psychiatrists, until we get more psychologists" in Utah.
"I am here to implore you on behalf of more families than I care to count who did touch a primary care physician, who again maybe they didn't have that training," Hiatt said. "This is just an opportunity for us to get one more piece of the puzzle complete. The more people (who) take suicide prevention on as their business, the more we will see this tide turn."
Paul Edwards, deputy chief of staff for Gov. Gary Herbert, testified in favor of HB87, saying the governor's recently formed Teen Suicide Prevention Task Force believes "the idea of gatekeeper training is a huge part of (its) recommendations."
"The statistics are just alarming," Edwards told the committee. "If we had something like a virus in our community that each year was affecting (and) infecting 15,000 people, with 600 deaths, we would see that as a public health crisis where we would say, 'Let's the get the appropriate training for every health care practitioner to know how to deal with that contagion.'"
Also Thursday, the House Health and Human Services Committee unanimously recommended HB370, which sponsor Rep. Steve Eliason said enacts several "major policy changes" to how suicide prevention is approached in Utah.
HB370 provides for state grant funds to go toward the creation of five mobile crisis outreach teams to assist in mental health calls by visiting a person's home. Eliason and other lawmakers have referred to such teams as the mental health counterpart to paramedic crews.
"(The outreach teams) are a key emergency room diversion technique that may reduce overall health care costs in both the private and the public sector," Eliason said.
Currently, the teams are only available along the Wasatch Front, he said, which the bill could fix. Eliason said the grants that support those teams will account for the vast majority of the slightly more than $2.5 million the bill will ultimately ask for.
The bill also amends regulations surrounding medical examiner records, allowing greater ability to "expand the scope of our investigation to include environmental factors" in a person's death through the access of new kinds of records, said Utah State Medical Examiner's Office Fatality Epidemiologist Michael Staley.
The measure also allows the agency to assist public health researchers in collecting valuable data for study, which isn't currently allowed for, Staley said.
HB370 also expands the role of the School Safety and Crisis Line program (which oversees the SafeUT app) among higher education institutions and increases the funding appropriated specifically to school-run suicide prevention programs.
Edwards, McOmber, and Hiatt all spoke in favor of the bill, as did the state board of regents.