Suicidality: Patient Engagement and Intervention
Encountering patients who express suicidal ideation can be unsettling and difficult. What is the right level of intervention? At what point do emergency services need to get involved? How can you support your patients through their most difficult moments in the least invasive and traumatizing way?
Beyond triaging patients who disclose suicidal ideation, how do you identify patients who may be at risk for suicide but are not (yet) willing to disclose such thoughts to you?
Starting the conversation
You may be anxious to directly ask your patient about suicidal ideation. Asking about suicide does not encourage suicidal thoughts. Talking about suicide can help reduce, rather than increase, suicidal ideation and lead to improvements in mental health.
Regular depression screenings with the PHQ-9 also provide an opportunity for patients to disclose thoughts of suicide or self-harm.
Patients may be reluctant to disclose thoughts of suicide or self-harm for a number of reasons. Few patients have an accurate understanding of when their care providers are required to notify the authorities, how to receive emergency and crisis care without law enforcement intervention or involuntary admission, and their rights should they be admitted. A little proactive education on your part has the potential to go a long way in gaining your patient’s confidence.
Determining suicide risk and interventions
Suicidality is complex and requires holistic assessment. Suicide risk is not static, but shifts along a continuum based on a variety of factors. Our Suicide Prevention Toolkit offers guidance for assessing suicidality and risk levels, and provides suggested interventions based on commonly observed patterns. Ultimately, however, your own clinical judgment of your patient’s wellbeing should be your guiding star.
Crisis support and intervention
Medications are not immediately effective in patients at imminent risk. For these patients, a safe environment is the most effective protective factor. A collaborative safety plan can provide patients with tools and resources to survive a crisis. To learn more about safety planning, review this blog post by Dr. Anitha Iyer.
Hotlines are also available for individuals and concerned loved ones. Any patient who expresses any sort of suicidal ideation, or who may be at risk for suicide, should be made aware of resources such as the 988 Suicide and Crisis Lifeline and NYC Well.
As of July 2022, the National Suicide Prevention Lifeline is now the 988 Suicide and Crisis Lifeline. Callers may now reach the Lifeline by dialing or texting 988 where trained counselors will listen, understand how the caller’s problems are affecting them, provide support, and connect them to resources if necessary. All calls to 988 are free and confidential, and the Lifeline is available 24/7.
What happens when you call 988?
Many patients are apprehensive about calling 988 due to concerns about emergency services involvement or inpatient admission. Read more about what callers can expect when speaking to a counselor.
Conclusion
It is incumbent upon all of us as health care providers to understand how to effectively engage patients in conversations about suicidality, as well as when and how to intervene.
Mount Sinai Health Partners is pleased to offer a variety of resources and educational materials on suicide prevention.