Engage patients at risk for suicide in a care plan 

Active Engagement for Safer Suicide Care

Engaging the Patient 

A fundamental premise of the Zero Suicide approach is that safer suicide care begins from the moment the patient calls the organization for an appointment or is admitted for treatment. For example, suicide risk immediately becomes a primary focus of assessment in a behavioral health or primary care setting if a patient indicates that he or she is currently having suicidal thoughts, has had suicidal thoughts in the past, or has made prior attempts.

Another fundamental premise is that all staff members have a crucial role in preventing suicide. At every encounter with a patient who is at risk of suicide, suicide risk should be assessed. This attention to suicidal patients by all staff members, clinical and non-clinical, requires a fundamental shift in what a health or behavioral health organization sees as its role.

Although a great deal of the focus of Zero Suicide is keeping patients safe from harm, engaging patients is not solely about making sure that they come in for sessions. The goal is for patients to grow, gain skills, and recover.

Actively engaging a patient about suicide risk includes the following:

  • Takes into account the individual’s experiences and resources
  • Builds hope for recovery
  • Empowers the individual to resolve crises and long-term problems using the least invasive methods possible

The result of active engagement in suicide care is that the patient feels heard, cared for, and empowered to make safe decisions.

Care that focuses on suicidal thoughts and behavior may be new and even overwhelming to apatient and family. The collaborative, nonjudgmental, comprehensive approach that is part of Zero Suicide may be a very different experience for many patients with suicide risk, especially if prior treatment has failed them. Staff members will need to take care to let patients know what to expect and guide them in how to use treatment effectively.

The following sections cover the fundamentals of engaging patients in safer suicide care.

Safety Planning

All individuals identified as at risk of suicide in primary care practices and clinics, hospitals and emergency departments, behavioral health organizations, and crisis services should have a safety plan.1

Collaborative safety planning is becoming standard practice in many behavioral health organizations and health systems. A safety plan is a prioritized written list of coping strategies and sources of support developed by a clinician in collaboration with patients who are at high risk for suicide.

A safety plan should:

  • Be brief, in the patient’s own words, and easy to read
  • Involve family members as full partners in the collaborative process, especially to establish their role in responding to patient crises
  • Include a plan to restrict access to lethal means, which is also balanced with respect to legal and ethical requirements under federal and state laws
  • Be updated whenever warranted
  • Be in the patient’s possession when she or he is released from care2

Safety Planning Intervention for Suicide Prevention is an online resource that we recommend be reviewed by all staff, clinical as well as relevant nonclinical staff. You’ll find a link to the resource on this page to the right.

Reducing Access to Lethal Means

Every safety plan should address reduction to access to any lethal means that are available to the patient. Limiting access to medications and chemicals and removing or locking up firearms and other weapons are important actions to keep patients safe.

Reducing access to possible methods of suicide may be one of the most challenging tasks a clinician faces with a patient. The Counseling on Access to Means (CALM) online training is offered free of charge by the Suicide Prevention Resource Center. We recommend that it be required of all clinicaland in some cases non-clinicalstaff members. A link to the training is provided in the Tools section.

Organization policies should clearly state what clinicians should do regarding lethal means, including the protocol to follow in the event a patient brings a weapon or other lethal means to the clinical setting. As an example, Centerstone’s Securing Weapons for Suicidal/Homicidal Clients can be found in Tools. This protocol outlines the steps for clinical and non-clinical staff to take when a patient brings a lethal instrument to a session. Centerstone is a large not-for-profit provider of community-based behavioral healthcare.

Readings

Development of a Clinical Guide to Enhance Care for Suicidal Patients
  • Web
Ethical and Competent Care of Suicidal Patients
  • Web
Building a Therapeutic Alliance with the Suicidal Patient
  • Web
Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk
  • Web

Tools

Counseling on Access to Lethal Means (CALM)
  • Web
Centerstone Education Sheet: Adding a Pathway to Your Treatment Plan
  • PDF

SPRC and the National Action Alliance for Suicide Prevention are able to make this web site available thanks to support from Universal Health Services (UHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (DHHS) (grant 1 U79 SM0559945).

No official endorsement by SAMHSA, DHHS, or UHS for the information on this web site is intended or should be inferred.