Note: National Suicide Awareness Week occurred this month and with that important week, we provide some reflection on the stunning realities of suicide, with particular emphasis on strategies to take in the hospital setting.
Suicide has been a rising area of concern in the U.S. for many years. Unfortunately, despite our efforts, the rates continue to increase at alarming rates. Recently, research has shown that an estimated 45% of persons who commit suicide visited the emergency department or their primary care physician within one month of the suicide (SAMHSA, 2016). To further demonstrate the importance of properly screening for suicide, additional statistics show that 20% of patients who commit suicide, have visited a healthcare organization within 24 hours of their suicide. During these visits, the suicide intent was not identified despite the patient providing cues.
Below are compelling statistics from the Centers for Disease Control (CDC).
- Suicide is the 10th leading cause of death for all persons, regardless of age
- Suicide is the 3rd leading cause of death for those aged 10-14; however, most organizations do not screen for suicide unless the patient is over 18. Simply asking youth about harm is not going to help us get the answers we need to prevent suicide in this age group.
- Sixteen percent (16%) who tried to commit suicide will try a second time
- In 2014, there were nearly 43,000 suicides
- average of 117 per day (AAS,2016)
Many times, these suicides or attempts are occurring within the walls of a healthcare setting. Suicide remains one of the most frequently reviewed Sentinel Events by TJC. This continues to be the case even though we ask everyone about their intent of self-harm. What is the missing link?
Accrediting and regulatory bodies are to be commended for their efforts to increase awareness about behavioral health issues, especially suicide. Healthcare professionals, unless they are trained in this area, are usually not comfortable (nor properly educated) discussing psychiatric issues. In order to identify patients that may be at risk for suicide, accrediting bodies are requiring that certain patients be asked about suicidal intent. There are several concerns with making suicide screening mandatory. The first concern is that organizations incorporate this screen into one of the many questions that are asked at the time of admission. And, typically they ask everyone, regardless of the requirements.
The second concern is the lack of education and orientation for the staff responsible for performing the screen. Requiring staff to just ask the questions is not the same as a true assessment. Additionally, those with true suicidal intent know how to “correctly” respond, many times, hoping that someone will pick up on the subtle cues that they are not doing well. Staff asking the questions should be taught not to rush through the questions. They also need to ask in a non-threatening and non-judgmental way. Many times staff will provide the answer they desire. For example, many times staff ask, “You don’t have thoughts of hurting yourself do you?” or “We have to ask this of everyone, do you have thoughts of hurting yourself?” This is not going to identify at-risk patients.
Accrediting bodies have opened the door for these uncomfortable conversations to occur. What we have to do is understand how this should be approached. Here are some recommendations to consider using in your organization:
- Make the suicide screen more than a task
- Collaborate with the experts if you have behavioral health services in your organization
- Consider having a group of specially trained staff in every area
- Focus on children and adolescents – the number of suicide attempts and rates are increasing
- Hire additional Mental Health Technicians and utilize them in high-risk areas, not just behavioral health
- Ensure that staff know when to refer and what to do when they have concerns about a patient
- Teach staff not to rely on just the final score of a suicide assessment, but look at all cues and have honest discussions about the needs of the patient
In closing, remember to teach that suicide assessment is more than a question on admission or handing out a resource list. As healthcare professionals, despite our area of expertise, we must understand suicide, how to properly assess and then provide appropriate interventions. There are many resources available for healthcare professionals to learn about suicide and statistics. Some resources include CDC, SAMHSA, AAS, The Joint Commission’s Sentinel Event Alert 56, National Alliance on Mental Illness and National Suicide Prevention Lifeline.
Logo and resources found at AAS, 2016. American Association of Suicidology retrieved from http://www.suicidology.org/.
CDC, 2016. Centers for Disease Control retrieved from www.cdc.gov.
SAMHSA, 2016. Substance Abuse and Mental Health Services Administration retrieved from http://www.integration.samhsa.gov/about-us/esolutions-newsletter/suicide-prevention-in-primary-care.
The Joint Commission. The Joint Commission Most Commonly Reviewed Sentinel Event Types. Retrieved from https://www.jointcommission.org/assets/1/18/Event_type_2Q_2016.pdf