Suicides in health care settings are a growing concern for hospitals, and the Joint Commission issued a new alert Wednesday afternoon, with eight steps providers can take to address it.
The commission says it received nearly 1,100 reports of suicides occurring in health care settings between 2010 and 2014. That's all the more concerning, according to the Joint Commission, because about 21 percent of its accredited behavioral health care organizations and 5 percent of accredited hospitals are noncompliant with its recommended practices to identify patients at risk of suicide.
“We are shining a light on this issue because the tragic reality is that many health care providers do not detect suicidal thoughts of individuals who eventually die by suicide, even though most victims of suicide received health care services in the year prior to death,” Ana Pujols McKee, M.D., executive vice president and chief medical officer for the Joint Commission, said in a press release. “As a result, it is crucial for at-risk patients to receive timely and supportive care.”
Nancy Foster, the vice president for quality and patient safety policy at the American Hospital Association, says hospitals are grappling with such behavioral health issues on a daily basis, and are seeking guidance. The association, too, has launched its own behavioral health initiative to help America's hospital treat patients plagued with mental illness or substance abuse disorders.
"I am hearing from all variety of our members that they are deeply concerned about what, in many communities, is a crumbling infrastructure for mental health," Foster says. "These patients come to us in many different ways, usually not complaining of a mental health issue, and in the very busy clinical settings of today, it’s really hard for clinicians to identify their problems in an appropriate timeframe."
The new sentinel event alert offers hospitals eight steps their clinicians can take to detect suicidal patients, in both acute and non-acute care settings:
1. Review each patient’s personal and family medical history for suicide risk factors.
2. Screen all patients for suicide ideation, using a brief, standardized, evidence-based screening tool.
3. Review screening questionnaires before the patient leaves the appointment or is discharged.
4. Take the following actions, using assessment results to inform the level of safety measures needed:
a. Keep patients in acute suicidal crisis in a safe health care environment under one-to-one observation.
b. For patients at lower risk of suicide, make personal and direct referrals and linkages to outpatient behavioral health and other providers to follow-up care within one week of initial assessment.
c. For all patients with suicide ideation: give them a number to the National Suicide Prevention Lifeline (800-273-TALK), conduct safety planning and restrict access to lethal means.
5. Establish a collaborative, ongoing and systematic assessment and treatment process with the patient involving the patient’s other providers, family and friends as appropriate.
6. To improve outcomes for at-risk patients, develop treatment and discharge plans that directly target suicide risk.
7. Educate all staff in patient care settings about how to identify and respond to patients with suicide ideation.
8. Document decisions regarding the care and referral of patients with suicide risk.
You can access the full Sentinel Event Alert on the Joint Commission’s website here.