Suicide Risk Management: Vital Signs for All Providers

By Bart Andrews, Director of Clinical Services, BHR and BHR Worldwide

There are over 38,000 completed suicides in the United States per year. It is the 10th overall leading cause of death and the 3rd cause of death for individuals aged 15-24. Over 90 percent of those who die by suicide meet criteria for a severe and persistent mental illness and the suicide rate has been increasing, particularly among our veterans and middle aged males. Over 28% of our youth report feeling sad and hopeless every day and 16% report having seriously considered suicide. 7.8 percent of our youth report having attempted suicide with 2.4% of our youth reporting the attempted suicide and required medical treatment.

Given the extent and prevalence of the problem, it begs the question of if we are doing a good enough job identifying and helping those at risk of suicide. Is asking about suicide a standard triage question at your agency? Would you be comfortable asking every client at your agency about suicide, regardless of reason for their visit? Do you believe it is appropriate to ask all clients about suicide? Hold on to those questions, we will revisit them a little bit later.

The basics of suicide screening: ASK! Yes, it is that simple with some guidance on how to ask. We all need to ask individuals we are seeing in a health care setting the following questions: 1) Are you currently thinking about suicide? 2) Have you had thoughts about suicide in the last two months? 3) Have you ever attempted suicide? The only thing we can do wrong in asking about suicide is fail to ask about suicide. Interestingly, individuals at risk of suicide report they feel worse when they have contact with a health professional and they are not asked about suicide. We are not planting the thought or encouraging suicide when we ask. In fact, when we do not ask, we are encouraging individuals at risk of suicide to not talk about it and increasing, not decreasing, the risk.

Some will ask about the need for suicide screening for all clients. I think this is fair question and one we need to explore. When a client enters a primary care clinic for a sprained ankle, we still take body temperature, blood pressure and other vital sign measurements. Why do we do this? It is clear that the person has an injured ankle but we will assess basic vital signs because we recognize that there may be more going on than just an injured ankle. If we do not assess, we do not know. We need to take the same approach with suicide screening. The facts will astound you. Why do we need to ask all clients about suicide:

While the underlying cause of these trends has yet to be determined, one thing is certain, a complete patient history, including screening for depression and suicide attempts, is an essential first step in the recovery and treatment planning process. BHR Worldwide’s clinical intake specialists are trained and ready to ask the right questions, look for the warning signs and assess clinical indicators – thus alleviating and reducing these crisis situations.

• 20% of primary care patients are struggling with mental disorders
• 85% of individuals who suicide have seen a primary care clinician within the last year
• 45% of individuals who suicide have seen a primary care physician within the last month
• Only 35% of these individuals sought out mental health assistanceh

Individuals struggling with depression, sadness, anxiety and suicide are our clients. The do not carry signs that tell us they are at risk or need mental health assistance. They are often afraid to talk about their thoughts of suicide or emotional struggles. Treatment providers of all kinds need to take an active role in asking about suicide and normalizing discussions about mental health and suicide related concerns. We also need to know where to turn if we identify someone as at risk of suicide and need support in linking them to appropriate services. Do you know if you have a local crisis line? Do you keep local crisis resource information at your office? Have you considered developing a formal relationship with local community mental health providers or crisis centers? Did you know there is a national suicide prevention lifeline that individuals can access by phone or email free of charge?

As we move forward in addressing our nation’s suicide crisis, we all need to think of new ways to help our most vulnerable clients. We have all assumed that if we get the word out and make it known that help is available, that that in need will come forward. I think to some extent, this is true. They are coming forward but we are not asking them the right questions. So now I ask again, why aren’t we asking client we come in contact with about suicide?

Important Resources:
National Suicide Prevention Lifeline
1-800-273-TALK (8255)
www.suicideprevention.org
Suicide Prevention Resource Center
www.sprc.org
www.sprc.org/for-providers/primary-care-tool-kit-partnership

Recent News

---

OhioMHAS Announces Community Innovations Initiative

The Ohio Department of Mental Health and Addiction Services announced it will invest $1.5 million next year in projects that help link non-violent offenders with community-based behavioral healthcare services. The investments into the 12 collaborative projects in 24 counties is part of the Department's new Community Innovations Initiative, which kicked-off last week at the University of Findlay. The funding was acquired through savings resulting from the consolidation of state-funded agencies for mental health and addiction services. ....More

 

Suicide Risk Management

There are over 38,000 completed suicides in the United States per year. It is the 10th overall leading cause of death and the 3rd cause of death for individuals aged 15-24. Over 90 percent of those who die by suicide meet criteria for a severe and persistent mental illness and the suicide rate has been increasing, particularly among our veterans and middle aged males. click here for More

 

Post-Traumatic Stress Disorder (PTSD)

After a traumatic experience, it's normal to feel frightened, sad, anxious, and disconnected. But if the upset doesn't fade and you feel stuck with a constant sense of danger and painful memories, you may be suffering from post-traumatic stress disorder (PTSD). It can seem like you'll never get over what happened or feel normal again. But by seeking treatment, reaching out for support, and developing new coping skills, you can overcome PTSD and move on with your life.   For more information, Click here  

Even Moderate Drinking in Pregnancy Can Affect a Child's IQ

Relatively small levels of exposure to alcohol while in the womb can influence a child's IQ, according to a new study led by researchers from the universities of Bristol and Oxford using data from over 4,000 mothers and their children in the Children of the 90s study (ALSPAC) and published November 14 in PLOS ONE. , click here.

---