Suicide prevention resources available for assessing at-risk patients

Blue Cross Blue Shield of Michigan supports the Zero Suicide Initiative, a Collaborative Quality Initiative supporting suicide prevention across Michigan. 

If a behavioral health screening indicates that a patient has risk factors for attempting suicide, the current standard of care is to assess the patient’s intent and risk.

We’ve compiled best practices that all medical care and behavioral health providers should incorporate into the assessments of their patients.

Resources for outpatient providers
The most common and established screening tool for depression is the Patient Health Questionnaire-9.** This questionnaire asks patients about depression symptoms they may have experienced in the previous two weeks.

Question No. 9 asks patients if they’ve had “thoughts that you would be better off dead, or of hurting yourself.” If a patient responds with an affirmative answer to that question, then an additional assessment should be conducted. A provider can use a tool such as Ask Suicide-Screening Questions.** 

If a screening indicates that a patient has a significant risk of suicidal ideation, the provider should complete the Columbia-Suicide Severity Rating Scale for adults** or children or adolescents.** It’s a precise and valid method that helps determine suicide risk factors to discuss with family members or other supporters of the patient.  

Recognizing warning signs is a reasonable step to assess and protect patients from harm. Examples of warning signs are a patient’s history of previous suicide attempts, the specificity of a patient’s intent and plan, and the availability of lethal means (ideation, method, access and intent). 

Based on the assessment, here are options for interventions:

• Helping the patient use coping strategies
• Enlisting social support, such as family and friends, to help distract from suicidal thoughts and resolve the crisis
• Contacting behavioral health specialists for consultation and treatment
• Taking steps to make the patient’s environment safe, such as having family or friends remove items from a patient’s home if those items could be used to attempt suicide

If providers don’t feel comfortable with or aren’t trained in performing these interventions, they should refer the patient to a mobile crisis team that can see him or her immediately. Mobile crisis teams can visit patients wherever they may be in their provider’s office, a school or work setting, their home or anywhere else. 

More information, including a list of behavioral health specialists and contact information, can be found at the Behavioral Health Crisis Care site.

The National Action Alliance for Suicide Prevention** has a host of resources to assist providers in assessing and helping maintain patient safety in the face of suicidal ideation. The Recommended Standard Care for People with Suicide Risk: Making Health Care Suicide Safe** is a summary report with recommendations for outpatient behavioral health, emergency room and primary care settings.

The Collaborative Care Model includes behavioral health specialists, such as a psychiatric consultant and behavioral health case manager, to assist medical practices in improving the mental health of their patients. 

Training and incentives are available to practices that register to become Collaborative Care practices. Behavioral health specialists who are part of the medical team — and assist the practice in treating behavioral health conditions — add backup and depth to the practice. These providers address situations with patients who are contemplating suicide and can provide expert direction in safely triaging or treating them. 

Primary care or obstetric/gynecologic practices interested in joining the Collaborative Care initiative should contact their physician organization for more information. Other questions can be directed to valuepartnerships@bcbsm.com.

Note: If providers encounter patients who present an imminent risk of harm to themselves or others, it’s their professional and legal responsibility to take appropriate steps to help ensure their safety. The steps include notifying family, and law enforcement if appropriate, to assist the patient in getting mental health treatment. 

Table 2 of this American Family Physician article** has a list of questions that can help outpatient providers assess suicidal intent and risk. 

Resources for inpatient providers

The Columbia-Suicide Severity Rating Scale serves multiple functions for inpatient behavioral health providers. It should be routinely administered for both internal and external documentation requirements. 

For inpatient behavioral health providers, using the scale for adults** or children or adolescents** serves several purposes:

• Detailed assessment of suicide risks at admission for treatment planning
• On-going assessment or reassessment of risk during a patient’s stay
• Evidence that the treatment intervention is effective
• Helpful resource that can be used to identify and mitigate risk factors during discharge planning:
• Provision of contingency management options, including psychiatric urgent care, mobile crisis and crisis stabilization resources in the patient’s community
• Consideration of a behavioral health advance directive prior to discharge
• A standard of care assessment tool for purposes of documentation and risk management
• Communication of the risk assessment to providers accepting the transfer of care going forward

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.