Suicide check requires diligence from clinicians
Suicide check requires diligence from clinicians
As much as risk managers may worry about the risk of patient suicide, they have to trust that the frontline clinicians are sufficiently skilled and dedicated to spotting patients at risk. The risk manager can, however, provide leadership and administrative support, according to suicide prevention experts.
A proper assessment of your current suicide screening and prevention is the best place to start when addressing the issue, suggests John Draper, PhD, director of the National Suicide Prevention Lifeline at the Mental Health Association of New York City.
Draper advises risk managers to get a clear picture of what your institution does and clinicians in various departments do to screen patients for suicide risk before trying to implement any radical improvements. The organization's history of patient suicides also is important, Draper says, because it can point to physical areas, certain scenarios, or certain patient populations that may need attention.
That assessment probably will reveal what the organization is doing right, but it might be harder to spot what is not being done, he says. For that task, Draper suggests consulting with a suicide prevention expert who can highlight any gaps in training and brief clinicians on the latest research. "The information on how to prevent suicide is not static, and what clinicians learned 10 years ago may not be all there is to know," Draper says. "For instance, there is some new research that shows a key way to know a person is serious about suicide is when they say they are a burden on others and the usual mitigating factors — children and other family members they want to live for — are in fact aggravating factors. They think that their living makes it harder on those loved ones."
Risk managers should ensure that nonmental health clinicians have adequate training in suicide prevention, says Shara Sand, PsyD, clinical assistant professor of psychology and assistant director of clinical training at the Ferkauf Graduate School of Psychology in the Albert Einstein College of Medicine at Yeshiva University in Bronx, NY. Because the risk of suicide is greater in the mental health field, administrators and clinical leaders sometimes focus exclusively on whether clinicians in those areas are adequately addressing suicide, she notes.
"We are really thoroughly trained in the social work, psychology, and psychiatry fields to recognize suicidal patients, but I would say that other physicians and nurses are often so focused on the physical body that this concern is overlooked," she says. "I don't say this to be critical, but my experience has been that primary care doctors often miss just basic depression, let alone suicidality."
One out of every three people will suffer from a major depression at some time in their lives, Sand says, and that prevalence means that simply asking a few questions of patients could spot potential suicides long before that person volunteers any information. Sand cautions that if a risk manager urges clinicians to screen more for suicidal tendencies, one very common response is that asking may actually increase the possibility of suicide by introducing the idea. That concern can be a significant obstacle, she says.
"People genuinely worry that the patient will say he never thought of suicide, but now that you mention it, that's a great idea. That's really not the case," Sand says. "A person who has never considered it seriously isn't going to be driven to suicide by an innocent question. But one who has considered it can benefit from being allowed to talk openly about it, about how much they've thought about the idea and whether they've made any plans."
As much as risk managers may worry about the risk of patient suicide, they have to trust that the frontline clinicians are sufficiently skilled and dedicated to spotting patients at risk.Subscribe Now for Access
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