February 24, 2016
Today’s landmark release of a Sentinel Event Alert from The Joint Commission is groundbreaking for suicide prevention in our nation.
Released today, Sentinel Event Alert 56, “Detecting and Treating Suicide Ideation in All Settings” and its requirements, will likely reverberate for decades to come, given The Joint Commission’s (TJC) prominence as a thought leader in patient safety, and its dominant accreditation role with more than 21,000 hospitals and health systems in our nation.
Not only does this Alert address suicide ideation detection and screening, risk assessment and safety, but importantly treatment, discharge, and follow-up care of at-risk individuals. Moreover, “this Alert applies universally to all patients in all settings” — and this is huge for all of these settings with which at-risk individuals may come in contact.
Astoundingly, the risk of suicide is three times as likely (200 percent higher) the first week after discharge from a psychiatric facility, and continues to be high especially within the first year and through the first four years after discharge (see Alert for citations). Bottom line? People discharged from inpatient psychiatric care for suicidality are not “all better” when they are released. Families, workplaces, communities and ongoing healthcare providers need to know this—and act appropriately in helping to safeguard these vulnerable individuals.
Key in today’s Sentinel Event Alert:
1. It calls out clinicians in emergency (ED) and primary care (PC), in addition to behavioral health care, as having “a crucial way in both detecting suicide ideation and assuring appropriate evaluation” for at-risk individuals.
Suicide prevention policy leaders have long recognized that ED and PC settings are often the frontline in recognizing and responding to suicidal people. Yet these fields have yet to be fully and appropriately integrated in assisting those at risk. With today’s Alert, this will likely begin to change.
2. It calls out behavioral health professionals as playing “an additional important role in providing evidence-based treatment and follow-up care.” The key words here are “evidence-based treatment.”
Unless behavioral health professionals are using a treatment intervention that has been shown in the research literature to directly address suicidality and treat it to resolution, they are falling short of current best practice, and of what are now requirements in this new Alert.
A cautionary word to systems when evaluating what is truly an evidence-based treatment: not all interventions are alike. Only a handful of interventions now exist with sufficient evidence base showing resolution of suicidality over time. These include Dialectical Behavior Therapy (DBT), Cognitive Therapy for Suicide Prevention (CT-SP), and the Collaborative Assessment and Management of Suicidality (CAMS). For more re evidence-based practices applied to treatment of suicidality, see the Feb. 2015 Zero Suicide webinar, “Principles of Effective Suicide Care: Evidence-Based Treatments.”
3. It urges health care organizations to integrate all key components of effective care for individuals at risk for suicide.
This includes identifying, developing and integrating comprehensive behavioral health, primary care and community resources so these people don’t fall through the cracks. For hospitals and EDs, critical is discharge follow-up and care transitions. Closing this post-discharge engagement gap between settings is vital for immediate and ongoing safety. “Owning” responsibility for a high-risk individual in the community, once they leave the hospital yet before they’ve walked into the outpatient clinic for their first post-discharge appointment, may not come naturally to providers, yet is key to keep people safe from suicide.
How can systems meet the new requirements put forth in today’s TJC Alert? Organizations making significant progress that is consistent with the Alert’s requirements include the Henry Ford Health System, U.S. Air Force, and Asker and Bærum Hospital near Oslo, Norway.