Suicide and Self Harm in a MD Office

posted by Kathy Everitt on Friday, November 30, 2018

Suicide and Self Harm in a MD Office

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 a referral network of mental health professionals already established and refer them for care within one week of assessment
      • Ask the patient’s permission to contact support/family members so that you can share your concern
        • HIPAA permits a clinician to contact family members/caregivers without the patient’s permission when the clinician believes the patient may be in danger to self or others
      • Determine whether law enforcement should be contacted
      • Keep the patient in the 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:
      • Include your decision-making process
      • All communications with patient and family members/caregivers
      • Why patient is at risk
      • Identify and detail any safety plans agreed upon to reduce the risk
      • Follow-up plans to support the patient

For more information:  

https://www.sprc.org/settings/primary-care/toolkit

https://www.jointcommission.org/sea_issue_56/

http://decisionsindentistry.com/article/identifying-risk-factors-suicide/

Blog Author

Kathy Everitt

Senior Risk Management Consultant

Kathy brings with her more than 30 years of professional liabil...

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