Throughout his career in emergency medicine, Dr. Steve Leffler knew the steps to treat the array of emergencies a patient could arrive with: chest pain, a broken arm, a fishhook.

But suicidal thoughts had no such playbook.

“I’ll be honest with you: Seeing someone with suicidal thoughts was very scary and challenging. I didn’t actually know what to do,” he said Friday.

Leffler, who now leads the University of Vermont Medical Center and its parent network, UVM Health, spoke to a roomful of mental health clinicians, philanthropists and advocates at the opening of a new Burlington outpatient clinic that, he said, will offer a better approach to treat this often impervious challenge. 

The Asha Clinic treats what’s known as suicidality as a health condition — rather than as a symptom. The clinic, which is part of UVM Medical Center’s Burlington campus and adjacent to Howard Center’s mental health urgent care, puts a heavy emphasis on research and training, in coordination with UVM’s medical school. The opening expands capacity for Vermont to treat suicidal patients in an outpatient setting, as the state has long struggled to meet the high level of need for mental health care.  

As of May, 57 Vermonters had died by suicide this year, according to data available from the state’s Department of Health. It’s a level slightly higher than the average of 50 for that same period in the years 2023 through 2025. However, the number of suicide-related emergency department visits Vermonters have sought this year — 2,954 — has dipped slightly from the average between 2023 and 2025. 

“It’s very, very clear to me and everyone who practices in this community and across the country that we need better approaches to suicide care,” Leffler said at the opening event. He thinks this clinic will offer that new approach.

The clinic puts a premium on something called Brief Cognitive Behavioral Therapy, a phased program for patients to recognize crisis triggers, develop strategies to manage them and build patterns of thinking that challenge them. The therapy is entirely centered on outpatient care, something Leffler said can significantly expand Vermont’s capacity for mental health care. The Asha Clinic’s maximum case load is 100. 

Craig Bryan designed and popularized this approach to suicidality alongside his co-author David Rudd and is widely considered a leader in clinical suicide prevention work and research. He now leads the Asha Clinic, and he brought six additional members of the team he previously led at the Ohio State University College of Medicine to the new program. 

Leffler stressed the importance of the research and educational facets of the clinic’s work and its relationship with UVM’s Larner College of Medicine. Recently, regulators have brought heightened scrutiny to the ways that UVM Medical Center’s academic medical mission can better benefit Vermonters, who subsidized more than $80 million of educational costs through commercial insurance payments in 2025. 

“This is exactly what we’ve been talking about,” Leffler told VTDigger. “Dr. Bryan doesn’t come to Burlington without the academic mission.”

In time, Leffler said, Bryan’s vision is to grow Asha’s offerings beyond the physical clinic and provide virtual care for patients all over.

The Asha Clinic’s explicit emphasis on suicide care, as a distinguished area from general mental health care, is borne from an experience of mental health care gone wrong. 

Vermonters Drs. William and Debra Lopez Gottesman lost their 25-year-old son, Alan, to suicide in 2015 after his long and open struggle with suicidal thinking. He had received treatment from his primary care physician, his therapist and his psychiatrist, according to the Gottesmans. He died as an inpatient in a psychiatric care hospital out of the state. 

A major donation from the Four Pines Fund, which the Gottesmans founded with the mission of supporting updated models of suicide care, is financing the creation and operations of the Asha Clinic. As a fledgling initiative, the clinic does not yet pay for itself, Leffler told VTDigger, but he said that’s not a reason to shy away from innovation, even as the hospital faces steep financial challenges. Clinic officials did not provide a dollar amount for the donation. 

“We’re not here today without their philanthropy,” Leffler said during the event. “In case you haven’t seen it on the news, there’s huge pressure in healthcare right now, in how we’re funding healthcare (and) how we’re providing services. The philanthropy that they generously brought forward is why we can do this. We’re going to save a lot of lives for this clinic.” 

If you are in crisis or need help for someone else, dial 988 for the 988 Suicide and Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) or text VT to 741741 for the Crisis Text Line.