Round Peg in a Round Hole: Crisis Center Collaboration with EDs to Prevent Suicide

By Adam Chu, MPH

Photo by Wil Stewart; unsplash.com

What if there was a way to reach those at risk for suicide before they reach out to you? For crisis centers that are partnering with emergency departments (EDs), it’s not a dream, it’s just Tuesday afternoon. Crisis centers are working with EDs to divert at-risk patients from EDs, intervene with suicidal patients who have arrived at the ED, and follow up with at-risk patients to keep them safe from harm.

Partnering with EDs to connect with those at risk for suicide has the potential to make a difference in many lives. Among the 1.4 million adults who attempted suicide in the past year, 60% received medical attention and 41% stayed in the hospital overnight or longer (Piscopo, 2016). Of those who died by suicide, nearly one-fourth visited an ED within a month of their death (Ahmedani, 2014).

Crisis centers have an especially important role to play in follow-up. The risk of suicide attempt and death is highest in the 30-day period following ED discharge after treatment for a suicide attempt (Knesper, 2010). Research has shown that follow-up is a cost-effective way to prevent suicide, yet nearly 70% of patients seen in EDs for suicide attempts never connect with follow-up care (Richardson, 2014; Knesper, 2010). Crisis centers are well-positioned to reach out to those in need of follow-up services to provide support and ensure continuity of care.

As a provider of crisis services, you know the value your center can provide. But what about EDs? If you reach out to the EDs in your community to make a case for working together, will they return your call? With over a million adult suicide attempts a year, suicide prevention is an issue that’s on the radar screen. In fact, in the past year the suicide prevention field passed several major new milestones reflecting increasing work with EDs:

• Hospital accrediting body The Joint Commission issued Sentinel Event Alert (SEA) 56: Detecting and Treating Suicide Ideation in All Settings, which prioritizes suicide prevention practices in a wide range of clinical settings and includes specific guidance for EDs
• The National Institute of Mental Health (NIMH) funded three Applied Research Toward Zero Suicide Healthcare Systems grants to study the effectiveness of comprehensive suicide prevention in health care settings
• More hospitals and EDs are asking organizations such as the Suicide Prevention Resource Center (SPRC), the Zero Suicide Institute, and state suicide prevention programs to help them implement Zero Suicide
• The National Action Alliance for Suicide Prevention released Crisis Now: Transforming Services Is Within Our Reach, which describes what can be done to improve suicide care in emergency departments and behavioral health crisis care in general

These and other similar developments indicate an uptick in the adoption of suicide prevention practices and recommendations in ED settings — which is where crisis centers come in. To work effectively with EDs, crisis centers should make formal agreements or contracts to provide follow-up services for patients to ensure that EDs:

• provide written information with your crisis center’s phone number to every patient with crisis center information on discharge
• explain the purpose, utility, and services offered by the crisis center to every patient and to every patient’s family or support system, both at the start of treatment as well as at discharge
• obtain patient consent prior to discharge for your crisis center to provide follow-up support

As highlighted in the Prioritized Research Agenda of the National Action Alliance for Suicide Prevention, suicide could be reduced by 20% through ED-based interventions. Crisis centers are uniquely positioned to help EDs to work toward this goal and to achieve lasting change in the lives of people at risk, especially people who experience barriers to accessing mental health services.

More resources:

Learn more about the ways crisis centers can support EDs in the care of those at risk for suicide at the Follow-Up Matters website. The Substance Abuse and Mental Health Services Administration has funded Lifeline grants to support ED discharge follow-up services through crisis centers. You can find out more information about some of these partnerships here.

Learn how ED health care professionals make decisions about the care and discharge of patients with suicide risk by checking out Caring for Adult Patients with Suicide Risk: A Consensus Guide for Emergency Departments.

Take advantage of the free online course Preventing Suicide in Emergency Department Patients, which addresses safety planning, lethal means counseling, patient-centered care for patients with suicide risk, patient safety during the ED visit, and incorporating suicide prevention into discharge planning.

Check out the expert presentation Patients at Risk of Suicide: What Emergency Departments Need to Know.

References:

Ahmedani, B. K., Simon, G. E., Stewart, C., Beck, A., Waitzfelder, B. E., Rossom, R., … & Solberg, L. I. (2014). Health care contacts in the year before suicide death. Journal of general internal medicine, 29(6), 870–877.

Knesper, D.J. (2010). Continuity of care for suicide prevention and research: Suicide attempts and suicide deaths subsequent to discharge from the emergency department or psychiatry inpatient unit. Newton, MA: Suicide Prevention Resource Center.

Piscopo, K., Lipari, R.N., Cooney, J., Glasheen, C. (2016). Suicidal thoughts and behavior among adults: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. Retrieved from: https://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FFR3-2015/NSDUH-DR-FFR3-2015.pdf.

Richardson, J. S., Mark, T. L., & McKeon, R. (2014). The return on investment of postdischarge follow-up calls for suicidal ideation or deliberate self-harm. Psychiatric Services (Washington, D.C.), 65(8), 1012–1019.

Adam Chu, MPH, Senior Project Associate, Health and Behavioral Health Initiatives, Suicide Prevention Resource Center, EDC

If you’re involved with a crisis center and interested in joining the Lifeline, a network of over 160 crisis centers around the country, please email lifelineinfo@mhaofnyc.org.

If you or someone you know is struggling with depression or thoughts of suicide, reach out. The Lifeline is available 24/7 at 1–800–273-TALK (8255).