Hospitals Can Improve Suicide Care Practices and Help Save Lives
Four strategies can reduce risk for patients following discharge
Suicide claimed more than 49,000 lives in 2023, the highest number ever recorded in the United States, according to federal data. Health care providers can play a key role in reducing that number, given that almost half of those who die by suicide visit a health care setting in the month before their death. Evidence-based protocols can help providers identify, assess, and connect these people to potentially lifesaving care.
“Most people at risk for suicide do not receive care in behavioral health settings, so providers in hospitals, emergency departments, and primary care settings—where at-risk individuals are more likely to interact—have an opportunity to identify individuals at risk and connect them to care,” said Dr. Brian Ahmedani, director of the Center for Health Policy & Health Services Research at Henry Ford Health in Michigan. His work in suicide prevention has helped change how U.S. health providers care for people experiencing suicide risk.
Many suicide care experts recommend universal screening, a practice in which all patients are screened for suicide risk regardless of the reason for their hospital visit. These screenings help identify more people experiencing suicidality—that is, suicidal thoughts, plans, or actions—than the standard practice of screening only patients with behavioral health conditions.
But this screening is just the first step. Trained professionals should perform risk assessments when individuals are identified as being at risk for suicide. “Screening will tell you whether somebody is at risk. Assessment of that risk will tell you why they are at risk, how acute that risk is, and what can be done to address that risk,” Ahmedani said.
Individuals who are discharged after receiving an assessment or care for suicide risk need a plan to manage any subsequent symptoms. Providers managing the discharge care process can help develop this plan. The protocol should include:
- Formal safety planning. Safety planning is a brief intervention in which a patient and provider collaborate on a written document in the patient’s own words about concrete steps that they can take to weather a suicidal crisis, such as coping strategies and sources of support to contact, including the 988 Lifeline.
- Lethal means counseling. Providers and patients should talk about keeping patients’ environments safe from objects that could be used in a suicide attempt, such as medications or firearms. “The conversation often focuses on firearms, primarily because more than half of gun-related deaths in America are suicides. The goal is to discuss firearm safety—much like discussing the importance of using seatbelts with car owners,” Ahmedani said.
- Warm handoff to outpatient care. If patients’ risk assessment indicates a need for further evaluation and/or treatment, their clinicians should introduce them to behavioral health providers who offer those services and schedule follow-up appointments. “If you are feeling hopeless and helpless because of your condition, it creates a barrier to cognitively make decisions and prevents you from doing things you need to do to get healthy, like finding the right provider, scheduling a follow-up appointment, and navigating insurance,” Ahmedani said. “It’s important for the discharge care provider to make those appointments before the patient leaves the hospital to increase the chances of the patient showing up for their appointments.”
- Follow-up contact. Providers should reach out to the patient within 48 hours of discharge to check on the patient’s health status and plans for continued care.
Current practices miss opportunities to provide essential care
The Pew Charitable Trusts, in partnership with the Joint Commission, conducted a survey of accredited hospitals in 2022 and found that only 8% had instituted all four discharge care protocols, despite evidence that these practices can improve patient engagement with behavioral health services and reduce the risk for suicide following discharge. More than 1 in 4 reported conducting none. The Joint Commission’s National Patient Safety Goal for suicide prevention requires its nearly 3,800 accredited facilities to have discharge policies and protocols in place for individuals with suicide risk, but it does not specify what these policies and protocols should be.
Health care system leaders, insurance providers, and state and federal policymakers can help ensure that more hospitals provide quality suicide care by:
- Expanding provider education and training. Despite frequent interactions with patients at risk for suicide, most health care providers lack formal training in suicide assessment and intervention, including how to effectively provide evidence-based safety planning. “Across the board, there is a significant lack of training in suicide care for providers, including behavioral health providers, therefore a vast majority of clinicians have no idea how to ask patients about their suicide risk and what to do if they are at risk,” Ahmedani said. “When providers understand what they are supposed to do, they are more likely to do it,” he added.
- Improving insurance billing and reimbursement. New Medicare billing codes for safety planning and follow-up contacts can help incentivize hospitals and health systems to administer these evidence-based interventions. Private health insurance coverage for these services varies significantly, and billing codes that can be used to reimburse for screening and certain discharge care procedures are underused because of challenges with billing practices. These new Medicare billing codes and expanded private insurance coverage of these practices could increase access to these services.
- Advancing state and federal policies. State and federal policymakers can take steps to improve suicide prevention services in hospitals and health care settings. For instance, policies that address workforce shortages, integrate mental health services into primary care settings, and improve coverage for these services have been shown to improve patient care.
“We have a responsibility to help save lives, and we are at the right place for change,” said Ahmedani. “Health systems are recognizing suicide as a major issue they need to respond to, and patients are demanding better care. So, we are at this inflection point where all these pieces are coming together to make a major difference, and I’m hopeful for the future.”
If you or someone you know needs help, please call or text the Suicide & Crisis Lifeline at 988 or visit 988lifeline.org and click on the chat button.
Farzana Akkas works on The Pew Charitable Trusts’ suicide risk reduction project.