A new Joint Commission alert outlines the actions healthcare providers in all settings can take to better detect and treat those at risk of suicide.
"We are shining a light on this issue because the tragic reality is that many healthcare providers do not detect suicidal thoughts of individuals who eventually die by suicide, even though most victims of suicide received healthcare services in the year prior to death," Ana Pujols McKee, M.D., Joint Commission executive vice president and chief medical officer, said in an announcement.
Indeed, inadequate assessment, particularly psychiatric assessment, was the most common documented root cause of the 1,089 reported suicides between 2010 and 2014. Furthermore, a little more than 21 percent of Joint Commission-accredited behavioral health organizations and 5 percent of commission-accredited hospitals failed in 2014 to conduct a risk assessment to identify patient characteristics and environmental factors related to suicide risk.
Therefore, the accreditor recommends that healthcare providers take the following actions to detect those contemplating suicide:
- Review each patient's personal and family medical history for suicide risk factors.
- Screen all patients by using a brief, standardized evidence-based screening tool that includes a question about any thoughts of suicide.
- Review screening questionnaires before the patient leaves and use secondary screeners for those who give a positive response.
When immediate action or safety planning is needed, the Joint Commission suggests adding behavioral health clinicians to the care team. The accreditor also suggests that providers:
- Keep patients in acute suicidal crisis in a safe healthcare environment with one-to-one observation. Ensure they are kept away from anything they could use to injure themselves, including bell cords, bandages, sheets, restraining belts, plastic bags, and elastic or plastic tubing.
- Directly refer patients at lower suicide risk to outpatient behavioral health for follow-up care within a week of assessment.
- Provide all at-risk patients and their family members the number of the National Suicide Prevention Lifeline (800) 273-TALK as well as numbers for local crisis and peer-support contacts.
- Develop a safety plan with the patient to identify possible coping strategies and that provides resources for reducing risks. Review and reiterate the safety plan at every subsequent interaction until the risk subsides.
For behavioral health clinicians managing treatment, the Joint Commission suggests that they:
- Establish a collaborative, ongoing assessment treatment process that involves other providers, family and friends.
- Develop treatment and discharge plans that "directly target suicidality" in addition to any underlying depression or other disorders using evidence-based interventions.
To improve education and documentation, the Joint Commission recommends providers:
- Educate staff in all patient care settings on how to identify and respond to patients considering suicide.
- Document decisions regarding care and referral of at-risk patients, including why the patient is at risk, in part to ensure good communication among providers.
Some hospitals are already on similar paths. Last fall, Dallas' Parkland Memorial Hospital said it became the first in the U.S. to screen all patients for suicide risk, FierceHealthcare reported at the time. The screenings found 1.8 percent of patients at high risk and up to 4.5 percent at moderate risk.
Researchers have concluded that hospitals need to increase mental health screenings and strengthen follow-up with at-risk patients to prevent suicides. One study found that 22 percent of patients admitted to a hospital after harming themselves killed themselves within three months of discharge--and 68 percent killed themselves within a year of discharge.