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:  

https://www.sprc.org/settings/primary-care/toolkit