Follow-up is an impactful and cost-effective method of suicide prevention. Research shows that follow-up with hotline callers and people recently discharged from an Emergency Department or inpatient setting has positive results for both those receiving care and those providing it.*
As many as 70% of suicide attempters never attend their first appointment or maintain treatment for more than a few sessions.
Many people lack access to available resources for care or are unaware of the resources that are available to them.
Patients can experience loneliness and despair following discharge – those that lack social supports can be particularly vulnerable.
Referrals from Emergency Departments or hospitals may not match the patient’s needs.
Provide 24-hour access to staff trained in suicide assessment and intervention
Thoroughly assess for risk of suicide, provide support, offer referrals, develop a safety plan, and dispatch emergency intervention, if necessary
Connect directly with local mobile crisis teams
Avert unnecessary ED visits and better ensure needed ED visits
Intervene when a caller is not willing or able to ensure his or her own safety
Follow up typically occurs within 24-48 hours following a suicidal crisis or discharge from an Emergency Department or Inpatient setting and can be done in a number of ways.
MAKE A PHONE CALL
Send a short text message
Write a letter
Visit at home
Connect over email
Step 1:
Assess Risk
Whether your patient was admitted for a suicide attempt or you just suspect suicide risk, it is critical to assess their mental health before discharging them.
ADULT PATIENT WITH SUICIDAL IDEATION OR POTENTIAL SUICIDE RISK
If your patient demonstrates some suicide risk – identified through universal screening, patient disclosure, or other indicators – this Decision Support Tool, developed by the Suicide Prevention Resource Center (SPRC), can help determine whether discharge following ED-based interventions may be appropriate or further assessment by a mental health specialist is needed to make a disposition determination.
Download DocumentADULT PATIENT WITH SUICIDE ATTEMPT AS REASON FOR VISIT
If your patient was admitted for a suicide attempt (or, scored >1 on the Decision Support Tool) a comprehensive suicide risk assessment should be conducted to determine immediate danger and to make decisions about treatment. The SAFE-T guide (Suicide Assessment Five-step Evaluation and Triage), developed by SAMHSA and based upon APA Practice Guidelines, may be used to meet this objective.
Download DocumentStep 2:
Determine whether to Discharge and Refer or Admit for Inpatient Care
Whether a patient is determined to require inpatient or outpatient care, it is important to begin the process of discussing Follow-Up care with them early on.
Adult Patient Admitted for Inpatient Care
A plan for Follow-Up care can still be passed on if a patient is determined to require in-patient care. Whether initially admitted for suicide attempt, or if risk for suicide is revealed post-admission, Follow-Up care planning is an essential component of any discharge plan. Even with extended or long-term inpatient stay, the benefits of a Follow-Up crisis care network can be discussed.
Adult Patient Discharged with Referrals
For all patients with suicidal ideation who are being discharged, at least one of the ED based suicide prevention interventions listed in this Consensus Guide for Emergency Departments should be provided, including a plan for follow up care. Always include crisis center/hotline information with every brief intervention provided and be sure to involve significant other(s) in the intervention if present.
Download DocumentStep 3:
Ensure Follow-Up Upon Discharge
Follow-up care should be seen as an integral part of service delivery for all patients, whether discharged from an extended inpatient stay or brief emergency room visit. Patients who discontinue outpatient care can also benefit from follow-up services.
Offer Follow-Up to Anyone at Risk
Structured, consistently applied protocols are essential for an effective follow up program. Obtain consent early in the patient’s care to ensure a plan is in place. Ensure the patient has a clear understanding of the follow-up service.
Clearly Describe Follow-Up Care
Follow-up care provides a safety net between contacts, ensures continuity of care, and continues the assessment and management of risk. Inform the patient that contacts may involve:
Mood check and risk assessment
Review and revision of safety plan
Review of discharge plan and upcoming appointments
Problem solving obstacles
Discussing follow-up care at the right time can save lives and hospital resources, and support those in need as they continue their journey towards recovery.