Continuing Care Is an Essential Part of Suicide Prevention

Acute care hospitals—which provide short-term, intensive medical care to treat illnesses or injuries—play a vital role in suicide prevention. Providers in these settings are well positioned to screen patients for suicide risk and address imminent safety concerns through evidence-based tools, such as safety planning and lethal means counseling, that help prepare individuals to return home safely.

But the focus on patient well-being should not end there. After a person is treated in the hospital for suicidal ideation or an attempt, ongoing care from outpatient mental health providers is typically necessary to promote long-term wellness and recovery. It is especially important to access this care soon after hospitalization as suicidal thoughts and behaviors often resurface—and frequently intensify—once individuals return home.

Research shows that a patient’s risk of suicide is exceptionally high in the first week after discharge and can persist for months. One study estimates that within the first 90 days after discharge from a hospital, the suicide rate of a person with any mental health disorder was 12.6 times higher than the rate for the general U.S. population. In the year following a visit to the emergency department for deliberate self-harm or suicidal ideation, a person’s suicide rate was 56.8 and 31.4 times higher, respectively, than the general population. Unfortunately, many people—about 35% of those admitted to hospitals—do not receive timely outpatient care. Numerous barriers, including difficulty finding a provider, scheduling delays, and insurance complications, can prevent a person from accessing needed outpatient care.

Steps to improve care transitions

To help reduce the likelihood of a future suicide attempt and support patients in their transition to outpatient care, hospitals can implement evidence-based discharge care protocols that help increase access to ongoing, coordinated, and consistent care. One of these tools is called a “warm handoff,” in which hospital staff members can make a personal introduction between the patient and a new mental health clinician before discharge. This introduction, which can be done in person or through telehealth, becomes a collaborative process that helps the patient establish an initial connection with the new provider. Patients who receive a warm handoff are significantly more likely to attend an outpatient appointment; a study of patients discharged from an acute care hospital found that warm handoffs (referred to in the study as “bridging strategies”) more than tripled the odds of patients successfully attending their initial appointment with outpatient care.

Follow-up contact from hospital staff, ideally within the first 24 to 48 hours after discharge, is a second critical intervention that has been shown to significantly reduce subsequent suicide attempts. This provider-to-patient connection creates another opportunity to assess patient risk, offer support, and help problem-solve any logistical or emotional barriers to accessing outpatient care.

Best practices suggest that staff members maintain weekly contact with the patient for the first 30 days post-discharge or until they confirm that the patient attended a first outpatient appointment. Some research has shown the benefits of continuing these contacts over longer periods of time: One study determined that the rate of suicide attempts was 33% lower among individuals who received up to three follow-up contacts compared with individuals who did not receive any.

Despite strong evidence showing that these interventions reduce future suicide attempts, a recent survey found that only 37% and 30% of Joint Commission-accredited hospitals have implemented warm handoffs and follow-up contacts, respectively. Hospitals report several challenges in providing these services, including a lack of access to mental health and crisis services, logistical concerns for tracking discharged patients, and provider-related issues such as increased burden and a lack of training on outpatient management of suicide risk. Hospitals can mitigate these barriers by streamlining tasks for providers, for example designating a staff member to be the primary care transitions support, further developing relationships with outpatient mental health providers, and using the new Centers for Medicare & Medicaid Services billing code for follow-up contact (“post-crisis follow-up care”).

Today many patients found to be at risk for suicide lack still-critical support post-discharge. Hospitals have a powerful opportunity to use evidence-based interventions that improve care transitions and help save lives.

Stacey Baxter works on Pew’s suicide risk reduction project.