APPROACHES TO SUICIDE PREVENTION
In July, The Joint Commission implemented a revised National Patient Safety Goal focused on reducing the risk for suicide for hospitals and behavioral health care organizations. It has several elements of performance, one of which addresses suicide screening using an evidence-based tool. It outlines standardized precautions for patients who are screened positive for suicide risk, including the need for one-on-one continuous monitoring and identifying and removing “ligature risk” factors in the immediate environment (items that may help someone carry out self-harm practices). The majority of inpatient suicides result from hanging.
“Because of the changes made in July, every hospital patient is now being screened for suicide risk,” Repique said. “Now we are identifying those patients that we may not have caught before as being at risk, and we have more patients coming to us for psychiatric treatment. More patients are now able to access the services they need.”
This is an important change in health care, as suicide is a growing public health issue. Suicide is the 10th-leading cause of death in the U.S.
A patient’s history of a prior suicide attempt is the best-known predictor for future suicidal behaviors.
“We need to identify history and risk for suicide to be able to provide help and resources, even after discharge,” said Elaine Delvo-Favre, D.N.P., M.S.N., UF Health Shand’s Nursing and Patient Services administrative director for nursing quality and regulatory standards.
UF Health uses the Columbia Protocol, also known as the Columbia-Suicide Severity Rating Scale, or C-SSRS, for suicide risk assessment through a series of simple, plain-language questions that anyone can ask a patient. Responses help users identify a risk for suicide, assess the severity and immediacy of that risk and gauge the level of support that the person needs.
Providers using the C-SSRS ask patients about:
- Whether and when they have thought about suicide (ideation)
- What actions they have taken — and when — to prepare for suicide
- Whether and when they attempted suicide or began a suicide attempt that was either interrupted by another person or stopped of their own volition
Suicide screenings are required on all patient admissions to our UF Health hospitals, our hospital based E.R.s and freestanding emergency centers, and the UF Health Florida Recovery Center. Regular screenings during a patient’s stay and prior to discharge help providers understand their thoughts and safety.
“The key is to help the patient being assessed look at their protective factors,” said Roxane Harcourt, LCSW, LMFT, UF Health Shands Psychiatric Hospital administrator. “What can we do to get them on the living side?”
“We’ve implemented a wellness plan so they know they’re not alone and it provides them options they may not have known were available to them, such as a list with phone numbers for their best friend or a suicide prevention hotline. That way they know someone will be available to talk to them.”
Suicide prevention is not solely about screening and requires a comprehensive focus.
Delvo added, “It is our responsibility to identify patients who are at risk of hurting themselves and at the same time ensure that we provide a safe environment for them to heal.”