Recommended Standard Care for People with Suicide Risk: A Critical Step Forward

May 18, 2018

News Type:  Director's Corner
Author:  Colleen Carr, MPH, SPRC Director of Policy and National Partner Initiatives, Education Development Center; Deputy Director, National Action Alliance for Suicide Prevention Secretariat

People who are in distress or experiencing a suicidal crisis should be able to walk into any health care setting and receive the care they need. While we can all support this statement in theory, it is not always the case in practice. Many individuals at risk of suicide who have contact with the health care system are not screened or assessed for suicide risk, or connected to the necessary follow-up supports, due to fragmented systems and inconsistent delivery of suicide care. Recent recommendations released by the National Action Alliance for Suicide Prevention (Action Alliance) seek to change that.

The Action Alliance is working with its national public and private partners to transform health care systems to better identify and support people who are at increased risk of suicide—a key goal of the National Strategy for Suicide Prevention (Goal 8). Research shows that over 80 percent of those who died by suicide had been seen by a health care professional in the prior year, and 64 percent of those who attempted suicide had a health care visit in the month before their attempt. Health care systems have a unique opportunity during these visits to help save lives by adopting a set of simple evidence-based clinical practices designed to reduce suicide risk. We know which practices are effective and feasible for these settings—now it’s time to get the word out so that knowledge is applied consistently within and across health care systems.

To learn more about the Action Alliance’s recommendations and efforts to transform care, we asked Action Alliance’s Deputy Director, Colleen Carr, a few questions about these new recommendations:

Q: Why are these recommendations needed?

A: We’ve known for a while that more can be done in health care settings to address suicide risk among patients, but there hasn’t been a central resource summarizing what different settings should be doing, at a minimum. I’ll never forget what a health care system leader said after an all-day stakeholder meeting, “I need something I can take to my leadership team and say, ‘Here, this is the package of what the evidence says we need to be doing, at a basic minimum, to keep people safe and prevent suicide.’” After that meeting, the Action Alliance brought together national thought leaders to develop recommendations for standard suicide care, based on advances in suicide prevention science over the last 15 years.

Action Alliance Executive Committee member Dr. Mike Hogan succinctly summarized the need for these recommendations when he said, “We have a moral imperative to use what we know works in health care to prevent suicide. Just as statins are used in the prevention of heart disease, we have access to an array of feasible, evidence-based practices that should be part of standard care that is provided to those with suicide risk. Doing anything less is unacceptable.”

Q: Can you tell us more about the recommendations?

A: The Action Alliance’s Recommended Standard Care for People with Suicide Risk: Making Health Care Suicide Safe aims to help health care systems better identify and support people who are at increased risk of suicide. The new recommendations offer practical, evidence-based actions that primary care, inpatient and outpatient behavioral health care, and emergency department settings can take to provide better care for patients at risk for suicide. The document includes a short list of clinical practices recommended for various health care settings, and practices evaluated to be evidence-based and feasible for implementation in different health care systems.

I want to emphasize that these are basic recommendations, and not the gold standard for suicide care in health care systems—that gold standard is Zero Suicide. While scaling up adoption of Zero Suicide nationwide will take time, these recommendations offer concrete steps every health care system can do in the short-term to keep patients safe.

Q: Now that we have recommendations for basic elements of suicide care, what still needs to be done in health care systems to help prevent suicide?

A: Today, the delivery of suicide care within health care systems is inconsistent. There are pockets of really great, innovative, cutting edge system transformation happening, but there are also systems relying on outdated practices. The recommended standard care aims to help all health care systems take solid, yet feasible steps to ensure that—at a minimum—an individual at risk of suicide receives a brief assessment of their suicidal behavior, safety planning, means reduction, and caring contacts outreach. These simple, relatively low-cost interventions have the potential—if done to scale in all health care systems—to move the nation closer to our goal of reducing the suicide rate 20 percent by 2025.