WASHINGTON – The National Action Alliance for Suicide Prevention released in April 2018 what the organization said was the first set of “standard care” recommendations for suicide prevention in people with suicide risk.
Care for people with a suicide risk in the United States “is not working very well. Evidence-based tools exist to detect and manage suicidality, but they are new and infrequently used” by many clinicians, including those seeing suicidal patients in primary care, emergency, or hospital settings, said, during a session on the new standard-care recommendations at the annual conference of the American Association of Suicidology.
The Action Alliance seeks to have the standard care recommendations widely disseminated and hopes the document will receive endorsement from other organizations, said Dr. Hogan, a health policy consultant in Delmar, N.Y., and a member of the eight-person panel that wrote the recommendations.
These recommendations specify interventions for caregivers in four separate settings: primary care, outpatient behavioral health care (mental health and substance use treatment settings), emergency departments, and behavioral health inpatient care (hospital-level psychiatric or addiction treatment). For each setting, the recommendations highlight one or more core approaches, and then specify standards for identification and assessment, safety planning, means reduction, and follow-up contacts.
For example, within the primary care setting, the recommendations say the goals are to identify suicide risk, enhance the safety for those at risk, refer for specialized care, and provide “caring contacts.” The specifications note that this is achieved with standardized screening and assessment instruments (the recommendations cite eight screening tool options and also suggest three different possible assessment tools); referral as appropriate; a brief safety-planning intervention (the recommendations list five options for this) that includes lethality means reduction along with follow-up to be sure that lethal means have been removed; arranging for rapid follow-up with a mental health professional; and follow-up contact by the primary care clinician within the next 48 hours.
According to Dr. Hogan, a motivation for releasing these recommendations has been the growing U.S. incidence of suicide, rising from 10.4 deaths/100,000 in 2000 to 13.3/100,000 in 2015, a 28% relative increase during a period when the rates of the top killers in the United States – cancer, heart disease, and stroke – were falling. Other telling statistics are that most people who die from suicide had seen a primary care provider during the year before death, and nearly half had seen a primary care provider during the month before their death.