Isolation And Risk Of Suicide

Deaths by suicide can be prevented when services are in place

According to The Department of Health and Human services, a staggering 55% of counties across the US do not have a single psychiatrist, psychologist or social worker. Incredibly, every one of those counties is rural. That means that for a person who is living in one of these areas who is at a high risk of suicide, a visit to the closest psychiatrist’s office to get the help they need requires hours of travel and missing up to a day of work, something that may not be possible.

According to a recent New York Times article, the isolation and loneliness that can come from living in a rural town, combined with lower income, health problems and family issues can have a negative impact on any resident. For those who are at risk of suicide, that impact could be much greater, especially when the help they need is hours away. Some posit that this isolation could be one reason for the increase of suicides in rural areas over the last few years.

Stigma associated with mental health puts patients at riskisolation

There is still a great deal of stigma associated with seeking help from a mental health professional, so much so that some people who need help actively won’t seek it for fear of  being seen coming or going from a psychiatrist’s office. This stigma is especially strong in rural areas, where the perception is that there is little expectation of privacy.

When there aren’t any dedicated mental health professionals in their area, a person may try to find help through other means. Some rely on friends or family members. Others may turn to drugs and alcohol. But many who need help seek it from their primary care doctors, whom they know and are comfortable with. According to a 2002 analysis published in the American Journal of Psychiatry, nearly half of the people who died by suicide had visited their primary care physicians within a month of their death. Most reported minor symptoms such as trouble sleeping or headaches.

Bridging the gap with integrated care

Unfortunately, this tendency to see the primary care doctor for mental health issues is quite dangerous. Most primary care physicians are not properly trained in identifying risk factors for suicide, which means they cannot protect those patients in the ways that are most needed. If those patients who went to their doctor for headaches or sleepless nights could then see a medical heath professional on the same day, they would have access to the standard of care they need to reduce the risk of dying by suicide. Because those services are rarely available in rural areas, thousands of people are put at elevated risk.

Experts cited in the Times article have suggested adding a mental health component to primary care practices, either by having an affiliated psychiatrist practicing in the same building or by using video conferencing to get patients immediately evaluated by an off-site psychiatrist. That way, patients can seek mental health services without having to go to a building specifically dedicated to mental health – and thus avoid the weight of the social stigma.

However, with limited space and resources available, adding these services in rural areas is a challenge. Additional resources are needed to provide those essential mental health services to those who are most in need of help. Just as importantly, the public needs to be educated about the high cost of letting mental health services suffer – and the social stigma needs to be replaced with an understanding that seeking treatment for mental health is no different from seeking treatment for any other medical issue.

If you or a loved one has been effected by a death by suicide, contact Skip Simpson today. He knows that a person who is at high risk of suicide cannot seek help that isn’t there. Contact him today for a free and confidential case evaluation.

Constant observation effective when carried out properly

If you are a mental health provider, you absolutely must read “Constant Observation of Suicidal Patients: The Intervention We Love to Hate,” by Mark J. Russ, MD (Journal of Psychiatric Practice, 2016;22;382–388). This study is a must-read for psychiatric and general hospital risk managers, staff, and attending psychiatrists – because it provides valuable information that can help you protect your patients from serious harm or death.

Constant observation (CO) is defined by Dr. Russ as maintaining uninterrupted, physically close visual surveillance of a patient. He says it has been a mainstay of the inpatient care of the acutely suicidal patient. But sadly, in many hospitals, rehabilitation centers and other residential facilities, patients at acute risk for suicide are not put under CO. This is a dangerous decision.

Though CO is the standard of care for these patients, some argue against its effectiveness. One argument against it is a lack of evidence to support its use. This is a tired excuse. Another is that CO is too expensive and time-consuming, as it requires a staff member to be with one patient at all times. This excuse, at its core, puts profits over patient safety.

Even with a clinician, nurse or other health-care professional allegedly near the patient, there have been a few reported deaths by suicide that have occurred while the patient was under CO. None however, explain how the attempt was made.constant observance

Attorney Skip Simpson has a case in which a patient was able to tie a sheet to a vent and hang herself while she was allegedly being constantly watched. The reason for this death was an unsafe environment of care, poor staff training and supervision, and lack of leadership in the hospital. These are all common root causes of suicide listed by the Joint Commission.

It costs money to have a safe place to keep suicidal patients, train and supervise staff and have solid leadership. It always comes back to money—money that bean counters don’t want to spend to protect patients. Skip Simpson will not give hospitals and incompetent leaders a pass, nor will juries.

Most, if not all of the cases of suicide by patients supposedly under CO involved clinicians and staff who did not uphold the strictest level of constant observation. Any time there is a shift change or other circumstance in which a patient is left unobserved, even briefly, there is the risk of a suicide attempt.

Patients deserve the highest level of care

Given the state of our knowledge for the past 20 years, at least, an argument against the effectiveness of CO cannot be made, according to Dr. Russ. Skip Simpson agrees. The axiom asserting that “the absence of evidence is not evidence of absence” applies in this circumstance. There may be weak reasons not to recommend CO as a strategy to mitigate suicide risk in the hospital, but lack of effectiveness cannot be one. The very fact that it would be unethical to test the question with a randomized controlled trial—where some patients are properly protected and others are not—speaks to the validity of its effectiveness.

Many experts agree that CO, like most other procedures, is most effective when all medical professionals are adhering to all safety protocols. The risk of suicide can be prevented by ensuring that all staff are properly trained and follow the proper care procedures. This process also relies heavily on communication between health professionals.

Another method of care for patients who are at risk of suicide is routine 15-minute checks, or Q15. However, this has proven to be ineffective and is dangerous. With this method of observation, patients at high risk of suicide are left alone for 15 minutes at a time. This puts highly vulnerable patients at even greater risk of a successful suicide attempt. Hundreds of patients die by suicide every year while being watched every 15 minutes.

In this respect, the healthcare field is lagging behind virtually every other field. For instance, the reason most new bridges are now safe – ironically – is that so many collapsed in the early days. Whenever a bridge collapsed anywhere, bridge engineers flocked to the site to learn why. Once they found out, they made sure no one ever allowed that problem to arise again. They followed the “stop-it-next-time” rule. In contrast, hospitals do a root cause analysis of their suicides and bury the results. The public, other hospitals, researchers, the CDC, and even the hospital’s own staff don’t know why the suicide on a Q15 occurred.

Predicting a person’s exact moment of suicide is difficult; this is a reason at-risk patients are hospitalized. Every 15-minute watch for acutely suicidal patients must be eliminated. Medical professionals must be properly trained in using appropriate safety protocols, including CO. Overall, there needs to be improvement in the quality of care to help reduce the risk of suicide. This is easy—it means that the priority in healthcare must be the patient, not the pocketbooks of healthcare executives.

If you have lost a loved one to suicide while they were in an inpatient program, hospital or residential facility, contact Skip Simpson today. He has the unique expertise to help you get through this difficult time.

Suicide Victim’s Husband Can Sue Her Doctor, Florida Supreme Court Rules

In a recent ruling, the Florida Supreme Court found that the husband of a Sarasota County woman who died by suicide nearly eight years ago can pursue a lawsuit against her physician.

Jacqueline Granicz was 55 years old when she died in October 2008. She had a history of depression. Her husband, Robert Granicz, took legal action against her primary care physician, Joseph Chirillo, arguing that the doctor’s failure to meet his duty of care resulted in her death by suicide.

They day before her death, Jacqueline called her doctor’s office to report that she was under mental strain, crying easily and having gastrointestinal problems. She did not speak directly with her doctor. Dr. Chirillo changed her antidepressant medication and referred her to a gastroenterologist when he learned about the call from an assistant, but he neither called her nor scheduled an appointment to meet with her.Wooden gavel on library background

This primary care physician failed his patient; he had to know he failed as soon as he heard of the suicide.

Jacqueline’s case highlights a major hazard to people who are already at risk of suicide: mental health malpractice. When a doctor-patient relationship exists between a person struggling with mental illness and a physician, the physician has a duty to provide competent care that would be reasonably expected of a doctor in similar circumstances.  Doctors and clinicians have long known what is expected of them in protecting suicidal patients, yet they fly in the face of danger by not doing what they should do. Only juries can correct this situation.

Some common types of mental health malpractice include:

  • Improper diagnosis.
  • Failure to conduct a proper risk assessment. If a physician or other mental health professional has reason to believe a patient may be at risk of self-harm or suicide, he or she has a duty to properly assess the risk of suicide. This assessment includes asking screening questions, eliciting information about suicidal thoughts, plans and behaviors, and establishing a rapport with the patient.
  • Failure to properly protect patients at high risk for suicide.

Medical providers and mental health professionals have a duty to appropriately and competently treat their patients, especially patients who are at risk of suicide. When that duty of care is breached and a patient dies by suicide, the victim’s family has the right to seek justice and hold those providers accountable.

A New Position on Prevention: The Zero Suicide Approach

The Zero Suicide Approach is a new treatment plan that focuses not only on the patient but also on the importance of the mental health professionals and loved ones in a patient’s life and the role they can play in treatment. This takes suicide prevention a step beyond an individual seeking help and makes it a collaborative group effort.

By using the eight steps laid out in the Zero Suicide Plan, mental health professionals can try to ensure that patients don’t die by suicide; not that fewer patients die by suicide but that no patients do. Zero is the number.

Suicide Malpractice AttorneyLead 

As with any treatment plan, the best way to implement new strategies is to have strong leadership. This means all mental health professionals must make it their priority to learn about any new tools or training methods that are available and use them to the best of their ability. Leadership has long been stressed by the Joint Commission (JC), an agency which accredits hospitals. Leadership also means that the Joint Commission stops giving high marks to hospitals with any suicides.  Giving high marks to hospitals with a suicide is misleading the public—the same public the Joint Commission should protect.  The JC should also stop hiding important information from the public. It should mandate that all sentinel events be reported to the JC with a full explanation on why the sentinel event occurred. At this point the public does not know how many attempted suicides have occurred in hospitals or within 3 days of discharge.  The public should know that the estimates of suicides in hospitals is around 1600 patients every year.   


Wanting to help someone at a high risk of suicide isn’t enough. All mental health professionals should receive the proper training to help their patients in the best way possible. The right tools make all the difference. Solid training should start early in professional schools but—mostly —the training is inadequate; this is another leadership issue. 


It is important for mental health professionals to identify and assess the suicide risk factors for each patient in their care. Such risk factors include: family and personal history of suicide or prior suicide attempts, feeling like you are a burden to others, feeling like you don’t belong, substance abuse, mental illness, recent loss (such as losing a home or a loved one), other drastic life changes (such as losing a job), and psychological conflict or trauma. Knowing each client’s history and risk factors will help mental health professionals find the best ways to treat their patients. However, knowing risk factors is not enough; professionals must learn how to elicit suicidal thinking. 


Interpersonal connection is a vital part of life and even more so for those who are at high risk of suicide. A high risk patient might experience feelings of loneliness or isolation. Regular contact with loved ones and the mental health professionals in their lives though phone calls, visits and messages reminds those patients they are not alone. This method should be used as often as possible.

Much as there are standards of care are when dealing with a patient with ailments such as high blood pressure or diabetes, so too should there be standards of care for treating patients with high suicide risk.   “Standard care” is what everyone does and most often wrong.  The test is “THE standard of care.”   “Standard care” is going 70 mph when “THE standard” is 55 mph. No policeman will accept “well everyone was going 70.”

Safety Planning

This method is replacing the common practice of the No-Harm Contract. One reason for this shift is that the No-Harm Contract has not been proven to be effective, nor does it encourage continued care. Unlike the contract, A Safety Plan is created by the clinician and the patient together. They discuss different strategies, triggers and coping techniques the patient has at their disposal and how best to implement them. Through this collaborative effort, the patient is more involved in their own care and they take a more active role in their treatment. 


This plan breaks treatment down into two categories:

Cognitive behavioral therapy: This method focuses on helping patients recognize the thoughts or feelings that may overwhelm them and teaching them alternative coping skills. Research has proven this to be an effective tool for suicide prevention.

Dialectical behavior therapy: There are four main components to this therapy: individual treatment, a skills training group, consultation team meetings and phone coaching. As with cognitive behavioral therapy, this method has also proven effective. 


The Zero Suicide Approach also focuses on continuing care. Initial treatment isn’t enough. It is imperative that all mental health professionals continue to be involved in a patient’s life, to continually reinforce the teachings and tools provided in the treatment plan.


The medical and mental health professionals must stay on top of a patient’s treatment. They need to use all of the most effective tools at their disposal and know how to integrate those tools into the patient’s treatment plan.

To learn more about the Zero Suicide Approach, click here.

Zero Suicide Conference Offers Suggestions for Reducing Death by Suicide

Death by suicide is a substantial public health problem, as more than 40,000 Americans commit suicide every year. Unfortunately, the efforts being made to reduce the risk of suicide- including commitment of patients with suicidal ideation- do not seem to be effective. Increased efforts must be made both to prevent inpatient suicide and to reduce the chances of suicide among individuals experiencing mental health issues who have not been committed to an inpatient facility.

Texas Suicide LawyerThe Cap Times recently reported on the Zero Suicide movement, which is developing a new approach to suicide prevention. The goal of the movement is to lower the number of suicides to zero. The founders of the initiative believe it is possible to prevent every suicide where patients are in the care of health providers.  At a two-day conference, the theory behind zero suicide was explained and a plan was outlined for preventing both inpatient and outpatient suicides within healthcare systems.

The concern from one of the leaders of the Zero Suicide movement is the insufficient progress being made in controlling the growing number of deaths by suicide.  As the rate of deaths by suicide climb, the responses of healthcare providers and healthcare facilities has been to make incremental change or to stay the course. This is clearly not having enough of an impact, as suicide rates continue to rise.

The goal of Zero Suicide is to make wholesale change in order to ensure no person at risk of suicide goes untreated or uncared for. The focus is also on providing more comprehensive treatment, rather than just addressing depression, and on enlisting the broader community in an effort to help people who may be considering death by suicide.

Community and health organizations can and should both play an important role in helping to reduce suicide, according to the theories of the Zero Suicide organization.  The program was first started at a health system where the leader of Zero Suicide worked as a vice president.  Suicide experts pushed back on the approach initially, arguing the goal of eliminating all suicides set the healthcare organization up for failure.  Despite the criticisms on the part of suicide experts, the healthcare center overhauled its systems of patient feedback, made timely access to care a priority, and demanded a complete modification of cognitive behavior therapy methods across all departments.

It became the policy at the organization to ask the patient if they had visualized death by suicide and to describe the method. The family and patient were then told they should remove the means which would make it possible for the patient to suicide using this desired method. This became a surprisingly effective deterrent.  With the efforts made by the health center, there was an 80 percent reduction in patient suicides over 10 years and there was one year in which no deaths by suicide happened.

The airline industry has a good handle on safe flying because it thinks about ways the system could fail and corrects the problem before it happens; the health care industry, on the other hand, does not have a black-box mentality; instead the healthcare industry evades, covers up, and spins every failure it has. As a consequence hospital errors are now the third leading cause of death in America. The health care industry does not want the public to know this fact.

Other health institutions may wish to consider following the lead of the Zero Suicide group and incorporating at least some of their techniques to try to bring down death rates.

Suicide Rate Surges to 30-Year High in United States

The suicide rate in the United States has reached its highest level since 1986 for nearly every age group in the country, according to statistics compiled recently by the National Center for Health Statistics.

The study examined the suicide rate for all age groups between 1999 and 2014, according to The New York Times. Nationwide, the suicide rate increased by 24 percent during this 15-year period. The study also compared the overall suicide rate nationwide dating even further back. In 2014, a total of 42,774 died from suicide or 13 per 10,000 people, the highest overall rate since 1986.

Some of the biggest increases in the suicide rate occurred among men and women 45 to 64 years old. The rate among women this age increased 63 percent between 1999 and 2014. Among men this age, the suicide rate rose 43 percent during the same time period.

Why did the suicide rate increase nationwide?

There are many reasons why experts believe more people are dying by suicide in the United States. One reason cited in The New York Times article concerns a possible link between suicide in middle-aged adults and concerns about work and personal finances. The Times cited a study conducted by Katherine Hempstead of the Robert Wood Johnson Foundation.

Other experts studying the issue believe that income inequality may be a factor. “This is part of the larger emerging pattern of evidence of the links between poverty, hopelessness and health,” said Robert D. Putnam, a professor of public policy at Harvard University, interviewed by The New York Times.

Those comments were echoed by Dr. Alex Crosby, an epidemiologist at the Centers for Disease Control and Prevention, who studied the association between the nation’s economy and its suicide rate dating back to the 1920s. “There was a consistent pattern,” Crosby said in an interview with The New York Times. “When the economy got worse, suicides went up, and when it got better, they went down.”

Other reasons why more people are dying by suicide

However, the statistics compiled by the National Center for Health Statistics did not include data about the income of the people who died by suicide. In addition, the theories linking suicide with economic downtowns cannot explain recent economic trends. Since 2010, the unemployment rate has steadily declined each year. As a result, some experts analyzing the issue have questioned whether a link exists between the economy and the nation’s suicide rate.

Instead, others have cited inadequate health care and failure to diagnose depression among adults as a possible explanation for suicides. Some mental health care professionals do not take patients’ warning signs of depression and suicide seriously, according to attorney Skip Simpson, who regularly works with families nationwide on negligence and medical malpractice cases involving suicide. As a result, people dealing with thoughts about suicide sometimes do not receive the necessary treatment they need to address such issues.

Disagreements Over the Best Method of Inpatient Care Provision

Providing mental health services is one of the most important roles a healthcare institution can fulfill, especially if a person is experiencing suicidal ideation. The right mental health care can save a life and can help to stabilize people with serious illnesses such as depression.  Unfortunately, not all healthcare providers are capable of offering appropriate services to people experiencing mental illness.

Part of the problem stems from disagreements over appropriate provision of care and the right methods to use for treating mental illness. WQAD recently reported, for example, on fights between hospitals over who is best capable of providing inpatient care and where the care should be provided. As hospitals and other healthcare service providers go back and forth on what help should be offered to patients, it is victims who often suffer because there is no clear plan for inpatient treatment which has been proven effective.

Disputes Over Providing Inpatient Care Can Harm Vulnerable Patients

WQAD reports a company called Strategic Behavior Health (SBH) is seeking to open a new mental health facility. SBH is already operating two psychiatric hospitals which treat patients using both inpatient and outpatient services, including a hospital called Peak View Behavioral Health. When SBH tried to open its third facility, the two largest local health systems objected.

The local health systems, UnityPoint Health Trinity and Genesis Health System, argued SBH would cherry-pick patients who could pay the most and would make it harder for existing facilities to provide appropriate mental healthcare services.  Local hospitals also believe inpatient care is outdated, while SBH agrees and asserts the benefits of inpatient treatment.

In addition to concerns about the type of care and the cherry-picking of patients, there are also worries about whether there are enough doctors in the local area to provide staffing for all of the healthcare facilities who treat patients with mental illness.  One advocacy group, for example, indicated the problem with providing healthcare services locally is not a shortage of psychiatric beds but is instead a shortage of qualified psychiatric professionals.

Unfortunately, this disagreement means an inpatient facility which could provide important help in mental health care and suicide prevention may not be built or there may be a delay in building.  If there is a shortage of qualified caregivers, it also means facilities providing mental health services could be understaffed or unqualified staff members could be hired. When there is an inadequate level of staffing and/or staff members are not properly trained, patients will suffer.

This is an especially big risk for patients who are receiving treatment for suicidal ideation because it will be necessary for these patients to be carefully monitored. If an inpatient facility does not provide the supervision and help they need, the facility could be held accountable for malpractice if a patient is seriously injured or dies while receiving care.

Can Inpatient Care for Mental Health Issues be Improved?

A quarter of adults in the United States meet the criteria for a diagnosable mental illness. More than 1,069,000 people in the country attempted suicide in 2014 alone, according to the American Association of Suicidology.

Americans spent as much as $69 billion on mental healthcare services back in 1999 and while there is no current accurate data, experts suspect the spending is significantly higher today than it was almost two decades ago. Unfortunately, despite the massive spending and the significant need for effective inpatient and outpatient treatment, the system designed to treat people with mental health issues is fraught with problems in the United States.

Pacific Standard recently published an in-depth report of some of the issues with mental healthcare services in the United States. The report highlighted problems with inpatient care facilities in particular – and suggestions for positive change.

Until more effective solutions are identified, however, patients will continue to be at the mercy of care providers who  likely are not  equipped to actually fulfill their role at treating illness and preventing death by suicide. When a death occurs either under the care of an outpatient care provider or while a patient is receiving inpatient mental health services, family members of the victim should consider pursuing litigation  to hold the care providers accountable and, importantly help change conditions in the mental health industry

Problems in the U.S. Mental Healthcare System

Pacific Standard Magazine reported on one situation in which the mental health commissioner for the state of Virginia took a trip to an inpatient psychiatric care facility run by the state. The commissioner saw a facility which appeared very functional, as he saw impressive presentations and met with residents. However, the entire system seemed so perfect the commissioner suspected a Potemkin village had been constructed for his benefit.

He was proved right when he dropped by unannounced several weeks later. Residents suffering from behavioral problems smelled of unwashed clothing and urine. Patients requiring intensive treatment were alone in rooms as staff members chatted with each other in hallways. Overmedicated patients were also everywhere, slouched on the couch in front of the television.

When the commissioner tried to take steps to fix conditions, he discovered quickly there was little he could do to improve things and he also discovered similar problems existed nationwide in care facilities. He has since written a book focused on the problems with the mental healthcare system in America as well as focused on suggestions for making positive changes.

Unfortunately, the problems he identified with inpatient care are only the tip of the iceberg when it comes to nationwide issues with mental health services. Some of the many issues include psychologists and psychiatrists relying on outdated treatments and insurers who refuse to pay for the care patients need.

Less than 15 percent of mental health care consumers actually receive care based on evidence, and those who don’t can suffer greatly from ineffective treatments.  When this poor care is provided to patients and suicide or other serious consequences result, it is important to pursue claims against those responsible to ensure there is at least accountability within the ineffective patchwork system for providing care.

Helping Teens Fight Suicidal Behavior with Inpatient and Outpatient Treatment

Suicide is the second leading cause of death among young people between the ages of 15 to 24 in the United States. According to the American Association of Suicidology, more than 5,000 young adults and teenagers in this age range die by suicide each year. Unfortunately, teen depression is not understood as well as it should be and treatment methods – including inpatient treatment – are not always effective at providing young people with the services and support that’s necessary.

When a teen receives inpatient or outpatient care and still takes his or her own life, it is important to determine if the mental health counselors or care providers lived up to their duties as required by law. A failure to provide appropriate care and to perform a proper suicide assessment can result in a claim against any care provider, while inpatient facilities can also be held accountable for failure to adequately  monitor patients to prevent death by suicide.

Inpatient and Outpatient Treatment Must Help Teens Fight Suicidal Ideation

Argus Leader recently took an in-depth look at the problem of teen suicide, sharing the story of a 17-year-old who took her own life after a lengthy battle with depression. The young woman was a volunteer and mentor to others who took dual credit classes and who planned to attend university in the fall. Unfortunately, her family had a history of mental illness and the young woman began to develop depression after a move and after her parent’s divorce when she was in the fifth grade. She was also a victim of bullying in school, and she began cutting which is a common coping measure for teens who struggle to deal with emotional pressure. She also attempted suicide in fifth grade, and was hospitalized in an inpatient treatment facility.

She ultimately would make several more suicide attempts and be hospitalized at the same inpatient facility several times before dying by suicide.  She received a variety of different treatments, including transcranial magnetic stimulation, which is a relatively new depression treatment aimed at stimulating nerve cells in the brain using magnets. Unfortunately, the treatment efforts were not successful and she died by suicide this year.

Her story is similar to the struggles endured by many other teens, who care providers often do not understand how to treat effectively. Efforts are underway to improve the care young people receive, and 20 states have now adopted the Jason Flatt Act to require public school personnel to complete required training on youth suicide prevention and awareness.

Awareness is important, but can only go so far if the teens who are identified as being at risk are not provided with treatments that make a difference in their depression. Unfortunately, if mental health care providers and inpatient treatment centers do not develop more effective ways of treating and preventing teen suicide, tragic deaths of young people will  continue to occur.

Emergency Rooms Can – and Should – Screen for Suicide Risks

Identifying people at risk of suicide is an essential step to providing these patients with the care they require.  A new study shows care providers in the emergency room have an important role to play in identifying people at risk; this is yet another study stating the obvious.  Healthcare professions in an ER setting must do their part to ensure patients are identified so they can receive appropriate care. If not, an attempted suicide may occur within minutes to hours of an unthoughtful disposition.

ER Nurses Can Help Identify Patients at Risk of Death by Suicide

NewsWise reported on the recent study showing the important role emergency room caregivers can play in preventing a suicide. The research was conducted by UMass Medical School.  Researchers discovered when emergency room nurses conducted a universal suicide risk screening, almost double the number of at-risk patients were identified. At-risk patients included those who were positively identified as thinking about suicide or patients with attempted suicide.

The study spanned a five year period. During this time, there were 236,791 visits to emergency rooms included in the study. Suicide risks screenings performed on patients increased from 26 percent to 84 percent of patients undergoing screening over the study period. This increased the rate of detection of suicide risk from 2.9 percent to 5.7 percent.

The suicide screening performed in the emergency room was simple. Nurses in the ER departments were trained to administer a brief questionnaire to patients focused on three risk factors for suicide: depressive symptoms, lifetime attempts to die by suicide, and active suicidal ideation.

Patients were identified as having a positive screen if they had either confirmed they have active suicidal ideation or if they had attempted to die by suicide within six months of the time of the visit to the emergency department.  With this screening process, a subset of patients was identified whose risk of suicide was serious enough the patients needed inpatient psychiatric treatment. Other patients were identified who needed additional evaluation and intervention resources such as a self-help safety card and information about a suicide prevention lifeline.

The lead author of the study indicated: “Our study is the first to demonstrate that near-universal suicide risk screening can be done in a busy ED during routine care. The public health impact could be tremendous, because identification of risk is the first and necessary step for preventing suicide.”  The lead author is correct and we applaud the entire team performing the research.  We hope that the study is transformed into action in the emergency departments and the study is not just a group soliloquy among academics.

No further efforts to help identify risk of suicide in emergency departments are needed at this time.  This need has been answered by the Suicide Prevention Resource Center last year, 2015.  Skip Simpson highly recommends the outstanding work produced by the SPRC: “Caring for Adult Patients with Suicide Risk: A Consensus Guide for Emergency Departments.”  This important work (the ED Guide) is designed to assist emergency department (ED) providers with decisions about the care and discharge of patients with suicide risk.