Did you know that in the United States 50 percent more people die by suicide each year than by homicide? Suicide risk may go unrecognized in individuals who present to hospitals for treatment of non-psychiatric issues. But when suicidal intent or risk is detected early, lives can be saved.
September 7 through September 13 is National Suicide Prevention Week, a time to raise awareness that suicide is the 10th leading cause of death in the United States with one suicide occurring on average every 12.8 minutes. This year’s theme is “Preventing Suicide: Reaching Out and Saving Lives.”
At Parkland Health & Hospital System, officials recognize that every day provides an opportunity to identify, intervene and help save the lives of individuals with mental health problems that can trigger suicide attempts. To ensure that all patients receive mental health counseling they may need regardless of the reason for their visit to a Parkland provider, this year Parkland launched a unique Suicide Risk Screening program.
The program is the first of its type in the nation, according to Kimberly Roaten, PhD, Director of Quality for Safety, Education and Implementation, Department of Psychiatry at Parkland and Associate Professor of Psychiatry at The University of Texas Southwestern Medical Center. A clinical psychologist working with Parkland patients, Dr. Roaten is one of the leaders who developed the new program.
“The Joint Commission requires healthcare providers screen all patients with psychological problems for suicide risk,” Dr. Roaten stated. “But we believe it’s important to screen everyone because some of this risk may go undetected in a patient who presents for treatment of non-psychiatric symptoms.”
In 2014 Parkland dedicated the resources needed to make this possible, which included hiring 12 psychiatric social workers, selecting a standardized and validated suicide screening instrument, building an algorithm in the electronic health record that triggers the appropriate clinical intervention depending on the patient’s answers to a few simple questions, and training all nursing staff to implement the program.
According to Celeste Johnson, DNP, APRN, PMH CNS, Director of Nursing, Psychiatric Services at Parkland, “We implemented suicide risk screening with all Emergency Department patients and hospital inpatients in February 2015. In late May, we transitioned from the previous screening program to the standardized suicide risk screening at all Parkland Community Oriented Primary Care health centers and also at the Correctional Health division for all inmates at the Dallas County Jail. Our goal is to screen every patient using proven screening tools that can help us save lives.”
To date, Parkland has screened more than 100,000 patient encounters at the hospital and Emergency Department, and more than 50,000 patient visits in outpatient settings. Parkland uses the Columbia Suicide Severity Rating Scale (C-SSRS), a validated screening tool, with adults 18 and over and the ASQ (Ask Suicide Screening Questionnaire) with 12- to17-year-olds.
The Parkland algorithm sorts patients into three suicide risk categories based on their answers to the screening questions: no risk identified, moderate risk identified and high risk identified. Those at high risk are immediately placed under one-to-one supervision, suicide precautions are implemented and an evaluation by a behavioral health clinician is initiated. Patients at moderate risk are automatically referred to a psychiatric social worker and usually are seen during the same visit. If a patient chooses not to speak with a psychiatric social worker during the visit, they will receive a follow-up phone call to provide additional support and resources.
Patients may come in with a sprained ankle or sore throat, but if their suicide risk screening shows that they are at moderate risk, Parkland’s clinical algorithm immediately alerts a member of the behavioral health team to come and speak with them. Before discharge, both moderate and high risk patients also are given information about suicide warning signs, suicide crisis center hotline numbers, and Dallas County community mental health resources.
Because suicide is the second leading cause of death among 15- to 24-year-olds, Parkland has recognized the need for screening youth as well as adults.
“Little data is available about the predictive validity of tools for screening children and adolescents,” Dr. Roaten said. “The best available is the ASQ and we are currently screening all 12- to 17-year-olds for suicide risk using this instrument. We hope to eventually pilot standardized suicide risk screening for children under 12 as well.”
So far, the suicide risk screening in the emergency department and inpatient units at Parkland has found 1.8 percent of patients to be at high risk and approximately 4 to 4.5 percent at moderate risk for suicide.
“To our knowledge we are the first big hospital system in the U.S. to implement a universal screening program for suicide risk and the data we are gathering will be significant for other organizations in the future,” Dr. Roaten said. She and her colleagues will publish their findings in the near future.
“Experts know that suicidal crises tend to be brief,” Dr. Johnson said. “When suicidal behaviors are detected early, lives can be saved. Anecdotally, we know that even within the first few days of implementing the screening program, we were able to intervene with patients at high risk.”
Dr. Roaten added that most people who are depressed or suicidal will benefit from “just the fact that someone asked them about their feelings. By simply showing concern, we are probably saving lives.”
Approximately 1 million Americans attempt suicide each year. It is estimated that 5 million living Americans have attempted to kill themselves. An estimated 4.8 million Americans are survivors of suicide of a friend, family member or loved one.
Mental illness, substance abuse, previous suicide attempts, hopelessness, access to lethal means, recent loss of loved ones, unemployment and vulnerability to self-harm are just a few examples of risk factors. High self-esteem, social connectedness, problem-solving skills, supportive family and friends are all examples of factors that buffer against suicide and suicidal behaviors, according to mental health experts.
The complete “Texas Suicide Safer Schools” report can be read by going to the schools and youth section of the library at the TexasSuicidePrevention.org website.http://www.texassuicideprevention.org/information-library/schools-and-youth-materials/
Note that the website also has a list of online resources for suicide prevention including best practice online trainings and apps.http://www.texassuicideprevention.org/training/educators-and-schools-online-training/
For more information about Parkland, visit www.parklandhospital.com.
