What Every Healthcare Team Should Know About Suicide Prevention

Suicide is the tenth leading cause of death in the United States, with nearly 45,000 people dying by their own hand each year, according to the CDC.  September 10, 2018, is World Suicide Prevention Day: an international day of awareness promoting programs and activities to support suicide prevention efforts. As healthcare organizations move toward more value-based models of care, they are increasingly relying on care coordination teams to help deliver the highest quality of care to patients who at high risk for suicide completion. 

“Teamwork is really important to effective suicide prevention,” says Caitlin Thompson, PhD, former executive director of the United States Veteran’s Administration Office of Suicide Prevention and now vice president of Community Partnerships at Cohen Veterans Network. “We’ve learned the people on these teams, regardless of their role, are in a unique position to ask the right questions and direct people to the places they can go to get help.”

But, Thompson cautions, it’s important that care coordination understand some basic tenets of suicide prevention care. Here are three things every care coordination team should know: 

• Let your champion guide you. Thompson says it’s important for all members of a care coordination team to be trained to identify risk factors for suicide-ultimately, it’s everyone’s responsibility to help further an organization’s prevention programs. But she says having a single champion who can help oversee a team’s efforts can make a huge difference in terms of results.

“When a team has that champion, an organization knows they have one person with an eye towards suicide prevention across any kind of outreach a care coordination team may be doing,” she says. “These teams often work with people who have chronic medical conditions.  It can sometimes be hard to see some of the suicide risk factors in those cases with everything else going on.  That champion can help guide the team-and make sure that suicide prevention is sewn into the fabric of every case, of everything they do.”

  2.  Don’t be afraid to ask questions. Gregory Simon, MD, a psychiatrist and senior investigator at Kaiser Permanente Washington Health Research Institute, says that studies have shown that simple questionnaires can help identify people who are at high risk for suicide.

“Many organizations give patients a standard questionnaire which asks about thoughts of death or self-harm,” says Simon. “If a patient says they are having these kind of thoughts on a regular basis, it’s important to follow-up.”

But Simon says that care coordination teams don’t have to rely solely on questionnaire responses. Questions about life events can also be helpful.

“Simple and straightforward questions can identify people at increased risk for suicidal behavior,” he says. “Ask about life events. Things like losing your job, the end of an important relationship-these are events that really matter and can help predict who may be struggling.”

  3.  Go beyond the checkbox. Many organizations have standardized protocols for care coordination teams to follow-up with patients who have exhibited one or several of the risk factors associated with suicide. But Simon says that care coordination teams need to resist the urge to make a single phone call or send a letter and consider that requirement met.

“Dealing with suicidal thoughts is usually an ongoing issue, needing ongoing solutions rather than just a one-time emergency,” he says. “And many people at risk for suicidal behavior get disconnected from care.”

Thompson agrees. “Care might have ended, for any number of reasons. But even if care has ended at your organization, there needs to be some level of consistent follow-up with anyone who is at high risk for suicide. If you think someone is going to fall through the cracks, then that person will probably fall through the cracks,” she says. “It’s up to the care coordination team to reach out. So, whether that’s someone making a call once a month for a while, or sending out regular letters or postcards saying, ‘Hey, just want to check in and see how you’re doing,’ those actions can really make a difference.”

Both Thompson and Simon say that, when it comes the care coordination team’s role in promoting suicide prevention, little things can and do mean a lot. 

“Suicidal behavior is more predictable than most people think. More predictable than we used to think,” says Simon. “And if we can reach out to these people we’ve identified during the course of care, we have the chance to get them help and make a difference.”

Kayt Sukel is a science and health writer based outside Houston, Texas.