How to Handle the Threat of Suicide and Self Harm in Your Practice
It is important to recognize the signs of suicide or self-harm in patients. Toward this goal, it can be beneficial to establish a policy that reinforces your commitment to all patients' safety and the agreed-upon actions to take.
Posted in Patient Experience on Friday, November 30, 2018
It is important to recognize the signs of suicide or self-harm in patients. Toward this goal, it can be beneficial to establish a policy that reinforces your commitment to all patients’ safety and the agreed-upon actions to take.
Any patient who verbalizes thoughts of harm to himself/herself or others or shows signs of self-harm should be assessed and protected from harm as much as possible.
Some areas to consider for your policy:
- The use of a screening tool (when and how it is used)
- The screening tool should be consistent with your patient population and used for all patients. For example a first step might be a tool such as the PHQ-2 (patient health questionnaire) that asks: Over the last two weeks how often have you:
- Shown little interest or pleasure in doing things? (rating 0 for not at all to 3 for nearly every day)
- Felt down, depressed or hopeless? (rating 0 for not at all to 3 for nearly every day)
- Re-enforce the importance that:
- Staff should listen for verbal clues such as expressions of hopelessness, not wanting to live or being unable to cope.
- These clues are especially important if the patient has a history of previous suicide attempts.
- Whenever a patient expresses an intent to harm, it should be taken seriously.
- Note any signs of self-harm (such as cutting, scars, bruising) and ask the patient about these signs
- Know the risk factors associated with suicide/self-harm as determined by the CDC (Center for Disease Control) and assess each patient for:
- History of previous suicide attempts
- Family history of suicide
- Serious illness or physical impairment
- History of depression or other mental illness
- History of alcohol or drug abuse
- Stressful life event or loss (e.g., job, financial, relationship)
- Loss of appetite, sleeping difficulty
- Social isolation
- History of interpersonal violence
- If you determine the patient to be at risk, your actions should reflect the crisis level:
- Know your community resources: where and how to get help
- Identify and offer coping strategies and provide resources for reducing the risk
- Have a referral network of mental health professionals already established and refer them for care within one week of assessment
- Ask the patient’s permission to contact support/family members so that you can share your concern
- HIPAA permits a clinician to contact family members/caregivers without the patient’s permission when the clinician believes the patient may be in danger to self or others
- Determine whether law enforcement should be contacted
- Keep the patient in the safe environment and ensure the patient is not left alone
- If the patient is determined to leave, refer them to a local ER
- If the patient does leave, request a safety check by law enforcement
- Document your actions in the patient’s record:
- Include your decision-making process
- All communications with patient and family members/caregivers
- Why patient is at risk
- Identify and detail any safety plans agreed upon to reduce the risk
- Follow-up plans to support the patient
For more information: