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Sounding the alarm about suicide risk.

The Joint Commission (TJC) issued a Sentinel Event Alert, noting that in too many instances healthcare providers are not recognizing signs of suicide risk in patients who present for care. While the agency calls on all frontline providers to screen for suicide risk, experts note the issue is of particular importance to EDs because this is one of the most likely places for patients at high risk for suicide to present. Beyond identifying risk, experts note emergency providers and staff must receive training to effectively manage patients at risk for suicide. Further, TJC calls for the development of appropriate referral sources and mechanisms for follow-up contact. TJC reports that between 2010 and 2014, its Sentinel Event Database received 1,089 reports of suicides. The most common root cause was inadequate assessment. According to TJC, in 2014 more than 21% of accredited behavioral health organizations and 5% of accredited hospitals were non-compliant with conducting a risk assessment to identify patient characteristics or environmental factors related to suicide risk. Beyond instances of obvious risk, strong tipoffs that suicide is a concern include signs of hopelessness or evidence that the patient has no sense of the future. Further, experts note the strongest indicator of a future suicide attempt is a past attempt, so evidence in the record of a past suicide attempt, or a family history of suicide, should be taken very seriously. Researchers found that a three-item instrument, dubbed the Patient Safety Screener-3, can double the number of patients identified as at risk for suicide over usual care in a busy emergency setting. Experts recommend asking screening questions during the primary nursing assessment for most patients, and at triage for patients who present with a primary psychiatric complaint. Some experts suggest regionalizing mental health care, much like the country does with trauma care. However, communities must ensure they maintain adequate funding for such endeavors.