Suicide: A concern for all health care providers

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Suicide: A concern for all health care providers – Part 2

January 14, 2019

Part 2 ? Addressing the issue of suicide and interventions that can be taken

The impact of the increasing suicide rate is very important for all health care providers. Proactive suicidal readiness for your practice is an important step in intervention. Don’t wait until a patient is suicidal – your practice should have a system in place that any provider can use to address this risk.

In a November 29, 2018, article, the Philadelphia Inquirer stated that U.S. life expectancy continues to decrease.¹ The article cites the Centers for Disease Control and Prevention report about overall deaths, and the effect of suicides and drug overdoses on this statistic.

What physicians and other health care providers can do to reduce suicide risk

Primary care practitioners and health care providers have a responsibility to assess all patients for depression, behavioral health disorders, and social determinants of health to evaluate for suicide risk and/or behavioral health concerns that require intervention.

Health care providers can use the following guidelines to help reduce risk:

Assess for risk factors (from Part 1 – Recognizing the role of all health care providers to address the issue of suicide):

relationship problems
perceived crisis experiences (past, present, anticipated future)
substance misuse
physical health problems
job or financial problems
criminal or legal issues
loss of housing

Incorporate depression screening or the Patient Health Questionnaire-2 screening questions into patient assessments at each visit. Complete a more detailed evaluation for patients that respond positively to questions on the screening tool. AmeriHealth and Magellan provide access to screening tools through Magellan’s Behavioral Health Disorders Toolkit located on the AmeriHealth New Jersey and AmeriHealth Pennsylvania websites.
Refer members with positive responses for depression screening to a behavioral health provider and follow up with the patient within 7 – 10 days.
Refer all members with positive responses to AmeriHealth Care Management. Health coaches can work with members on medical and social care needs and will collaborate with Magellan case managers to coordinate medical and behavioral health care for the best outcomes.

Develop a safety plan with the patient

The American Foundation for Suicide Prevention has done extensive research regarding safety planning to reduce short-term risk. A safety plan can be developed with the patient and should include:

the warning signs of increasing risk;
personal strategies to de-escalate the suicide crisis; and
limiting access to any means that a patient has indicated they might use in a suicide attempt.

Since behavioral health professionals have the expertise to manage suicide risk, a safety plan should always include a referral. If there is not a consistent behavioral health provider working with the office, it is important to review the behavioral health access number on the patient’s insurance card, so the patient can contact them for a referral. Patients should be strongly encouraged to contact a behavioral health provider before leaving the office. Patients with Magellan Health Services may access the crisis line by calling 1-800-688-1911 and selecting option “1” to speak to someone immediately.

Call 911

Suicide attempts are a call for help. Do not let your patient leave the office if the threat of suicide is imminent or if they have an identified plan for suicide. Make sure the patient and all identified support people are educated on 911 and when to call.

Important additional steps:

Not allowing a patient to leave the office without the National Suicide Prevention Lifeline phone number – 1-800-273-8255.
Contacting family or 911 for transportation to the closest psychiatric crisis center, if necessary.
Asking the patient to contact their support person before leaving the office.

It is important to keep in mind that a patient may not be at high risk for suicide but may be concerned about a family member who is at high risk, so it is important to ask questions about their family concerns.