Handling the Threat of Suicide in Your Office
by Kathy Everitt
Friday, November 30, 2018
An unfortunate topic in the news of late is the dramatic increase in the suicide rate. This has been brought to the forefront by recent celebrity deaths.
You and your practice can be instrumental in recognizing the signs of suicide or self-harm in patients and providing them with needed resources. It can be beneficial to have a policy that identifies the steps you and your staff should take when such a situation presents itself.
This policy reinforces your commitment to all patients’ safety and the agreed-upon actions to take. Any patient who verbalizes thoughts of harm to himself/herself or others or shows signs of self-harm should be assessed and protected from harm as much as possible.
Some areas to consider for your policy:
- The use of a screening tool (when and how it is used)
- The screening tool should be consistent with your patient population and used for all patients. For example a first step might be a tool such as the PHQ-2 (patient health questionnaire) that asks: Over the last two weeks how often have you:
- Shown little interest or pleasure in doing things? (rating 0 for not at all to 3 for nearly every day)
- Felt down, depressed or hopeless? (rating 0 for not at all to 3 for nearly every day)
- Re-enforce the importance that:
- Staff should listen for verbal clues such as expressions of hopelessness, not wanting to live or being unable to cope.
- These clues are especially important if the patient has a history of previous suicide attempts.
- Whenever a patient expresses an intent to harm, it should be taken seriously.
- Note any signs of self-harm (such as cutting, scars, bruising) and ask the patient about these signs.
- Know the risk factors associated with suicide/self-harm as determined by the CDC (Center for Disease Control) and assess each patient for:
- History of previous suicide attempts
- Family history of suicide
- Serious illness or physical impairment
- History of depression or other mental illness
- History of alcohol or drug abuse
- Stressful life event or loss (e.g., job, financial, relationship)
- Loss of appetite, sleeping difficulty
- Social isolation
- History of interpersonal violence
- If you determine the patient to be at risk, your actions should reflect the crisis level:
- Know your community resources—where and how to get help
- Identify and offer coping strategies and provide resources for reducing the risk
- Have an established referral network of mental health professionals and refer patients for care within one week of the assessment
- Ask the patient’s permission to contact support/family members so you can share any concerns
- HIPAA permits contacting family members/caregivers without the patient’s permission when the clinician believes the patient may be in danger to his or her self or others
- Determine whether you should contact law enforcement
- Keep the patient in a safe environment and ensure the patient is not left alone
- If the patient is determined to leave, refer them to a local ER
- If the patient does leave, request a safety check by law enforcement
- Document your actions in the patient’s record:
- Your decision-making process
- Communication with the patient and family members/caregivers
- Why the patient is at risk
- Agreed upon safety plans
- Follow-up plans to support the patient
For more information: