What is the hospital protocol for suicidal patients? (+Levels of care)

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Page last updated: 12/11/2022

This article will be discussing what the hospital protocol is for suicidal patients. We will also be checking out the various levels of patient care which are available for those who are coming in feeling suicidal.

What is the hospital protocol for suicidal patients?

The hospital protocol for suicidal patients in most countries today has been described in the following points,

Taking initial safety precautions

The first thing that can be expected during a visit to the emergency department is initial safety precautions. Since this is a case of feeling suicidal, the person may be kept in a place which is free of any dangerous objects.

Educating the patient about what to expect

The next thing that the people in the emergency department might do is simply take the patient and their caregivers through the entire process of their visit to the hospital. They might also ask if the patient requires special attention to food or other such things during their visit.

In this stage of the protocol, the caregivers or the attendees of the patient may also be asked in brief about the suicide attempt. If the patient is willing to speak, they might be quizzed about their present mindset and plans.

First level of screening

After the patient has been educated, the emergency department may undertake a primary screening of the situation. The most commonly used primary screening tool is the PHQ-9 or the Patient Health Questionnaire which evaluates the patient’s current mindset.

Another tool which is used during the primary screening which directly evaluates the suicide is the Decision Support Tool. Through this tool, the patient’s actual attempts, any co-existing mental illnesses and addiction issues will be addressed.

While the PHQ-9 is pretty enough for those suicidal patients who are considered low-risk, the Decision Support Tool is often used for only those who are deemed high-risk patients showing suicidal behavior.

Second level of screening

Once the primary level of screening is over, the patient will be assessed once more through a more detailed assessment tool. The most commonly used tool for evaluating suicidal patients in the secondary level is the SAFE-T test.

The SAFE-T test or the Suicide Assessment Five-Step Evaluation and Triage, is a five-step assessment tool which can be used by clearly evaluate the patient’s actual suicide risk. The protocol also offers recommendations for interventions to be used for each stage.

Providing interventions

Once the primary and secondary levels of screening have been completed, the emergency department will be directed to offer possible interventions. The first type of intervention is most basic and is called the Lethal Means Restriction.

Here, the patient will be asked about how accessible they are to lethal means. Lethal means can different depending on the region that the patient is from. The patient and their attendees will be advised to restrict or monitor the access to lethal means like firearms and drugs.

Next, the patient’s assigned provider in the emergency department will sit with them and create a Safety Plan. This Safety Plan will be used by the patient when they are feeling too distressed and going through an emotional upheaval.

The Safety Plan can differ from person to person but mostly contains information about triggers and also emergency contacts. Apart from these, the Safety Plan may also direct the person to perform certain activities or exercises to distract from suicidal thoughts.

Discharge and referrals

After the intervention has been provided to the patient, the provider will then decide if they can be discharged or not. Mostly for low-risk patients, an immediate discharge may be suggested after careful explanation of the Safety Plan.

However, if the person seems like they belong in the high-risk category, they may be advised to admit themselves or may have to stay for much longer before they are discharged. Before any patient is discharged, they will also be referred to a provider and given the contact details.

Levels of care in a hospital for suicidal patients

For suicidal patients who are hospitalized, there are several levels of care depending on what risk-level they fall under. Not all suicidal patients need to be admitted and many can be treated through outpatient care. The different levels of care for suicidal patients are:

  • Outpatient Treatment: For those patients who are considered very low-risk, outpatient treatment is mostly recommended. For them, outpatient therapy sessions may be recommended a few times a week with a provider along with one group therapy session.
  • Intensive Outpatient Program: For those who are considered a medium-risk level, they might be recommended to go for the Intensive Outpatient Program. In this program, the person comes in for a few hours for about three to four days in a week.

This is recommended for those who are safe to be left alone at home but require way more therapy and care for their emotional issues. This can also be advised for those who need to go to work or have classes and cannot skip for many days together.

  • Partial Hospitalization Program or PHP: The Partial Hospitalization Program is recommended for those who are even a risk level higher. Here, the person spends most of their days in the hospital and can go home to sleep.

In PHP, the person comes in everyday throughout the week, but can opt to stay home fully during weekends. In this program, the person is recommended to undergo one on therapy, group therapy and even have access to a psychiatrist.

  • Inpatient Hospitalization or IP: For those who are considered high-risk, full-time inpatient hospitalization may be recommended. Here, the person is required to spend all their days and nights at the hospital where they will be supervised and taken care of.
  • Most hospital protocols state that a minimum of five days or seven days are required for an inpatient hospitalization for suicidal behavior. However, this can extend depending on the complications of the situation.
  • The inpatient hospitalization may not necessarily be in the one that the emergency visit has taken place. It may be different and may also be in a set-up which is particularly meant for behavioral health or mental health.
  • Unlike the other types of interventional programs for suicidal behavior, inpatient hospitalization may seem like the blandest since the patient is completely cut off from their freedom and pleasures.
  • In such a situation, the patient can expect to wear only loose fitting clothes with no sharp objects. Even simple strings like shoe laces and strings in clothes may be taken off. The patient will also be constantly monitored and the hospital will check in every 15 minutes.
  • The primary aim of inpatient hospitalization is stability. And therefore, one-on-one sessions with a therapist, psychiatrist visits and group therapy sessions are carefully planned. Also, recreational therapy, art therapy, occupational therapy will be provided.

Conclusion

This article has discussed what the hospital protocol is for suicidal patients. We have also checked out the various levels of patient care which are available for those who are coming in feeling suicidal.

If you like this article, please post your comments and questions in the space below.

Citations

https://www.pewtrusts.org/en/research-and-analysis/articles/2022/08/26/how-are-hospitals-helping-patients-at-risk-of-suicide
https://www.aap.org/en/patient-care/blueprint-for-youth-suicide-prevention/

http://www.nysed.gov/news/2022/mental-health-education-and-suicide-prevention-resources-now-available-schools-develop

https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/suicide.pdf
https://www.health.nsw.gov.au/mentalhealth/resources/Publications/suicide-risk.pdf
https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/care-systems-for-self-harm-and-suicidal-behaviour.pdf
https://store.samhsa.gov/sites/default/files/d7/priv/sma18-4357eng.pdf
https://www.sciencedirect.com/science/article/abs/pii/S0749379717306463
https://link.springer.com/article/10.1007/s40609-018-0127-7
https://www.mayoclinic.org/diseases-conditions/suicide/diagnosis-treatment/drc-20378054