In 2016 > 6,000 young people in the US killed themselves, according to the CDC. Most visited a health care provider or medical setting in the month prior. That means health care settings are not ideal for suicide intervention efforts. Researchers from the National Institute of Mental Health (NIMH) offer advice on how hospitals can address the rising suicide rate in a way that “is flexible and mindful of limited resources”—that is, an easily administered screening survey that provides immediate actionable response.
The NIMH report presents a 3-tiered clinical pathway system, created by a subcommittee of the Pathways in Clinical Care workgroup of the Physically Ill Child committee of the American Academy of Child and Adolescent Psychiatry.
The first step is an initial screen of all patients aged 10 to 24 years (for those with mental health issues, aged > 10 years), using the Ask Suicide-Screening Questions (ASQ) tool.
The first screening tool developed specifically for pediatric patients, the ASQ is free and available in 14 languages. Four questions (for example, “In the past few weeks, have you wished you were dead?”) take about 20 seconds to administer. A “yes” to one or more identified 97% of youth at risk in an NIMH study.
The second step is the most critical, the researchers say: A brief suicide safety assessment, which takes about 10 to 15 minutes to administer. This classifies a patient’s risk of suicide based on survey responses and clinical judgment.
The third step, if deemed necessary, is a full comprehensive safety evaluation by a licensed mental health provider, with the goal of addressing safety issues and establishing an intervention plan.
One of the biggest barriers to screening, NIMH says, is how to effectively and efficiently manage the patients who screen positive. Therefore, NIMH recommends that each health care setting have a plan. The ASQ Toolkit is designed to help with such a plan and to provide tools for managing care. The toolkit is organized according to medical setting: emergency department, inpatient medical/surgical unit, and outpatient primary care and specialty clinics. The kit includes information sheets, the Brief Suicide Safety Assessment Guide, nursing scripts, and information for parents and guardians.
The ASQ Toolkit is available at https://www.nimh.nih.gov/labs-at-nimh/asq-toolkit-materials/index.shtml.