July 2015
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Recommended Courses*

  • #610714 Elderly Populations and Suicide
  • #46016 / #63216 / #35814 Employee Health and Safety: Suicide Prevention and Intervention
  • #42914 What Everyone Needs to Know About Preventing Suicide
  • #90714 / #610614 Suicide Prevention and Veterans
  • #90715 Adolescent Suicide
  • #62016 What Works to Prevent Suicide

* course numbers may vary by facility

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September 2016

National Suicide Prevention Week

National Suicide Prevention Week, sponsored by the American Association of Suicidology (AAS), has been observed every year since 1975. This year’s observation occurs September 5 through 11 and corresponds with World Suicide Prevention Day on September 10.

The American Foundation for Suicide Prevention (AFSP) estimates that suicide in the U.S.:

  • Is the 10th leading cause of death
  • Claims 42,773 lives each year — that’s 117 lives per day
  • Occurs at a rate of nearly 13 per 100,000 individuals
  • Costs $44 billion annually
  • Is most often carried out by a firearm, accounting for 50% of all suicide deaths

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 77% of people who die by suicide are seen by their primary care physician within one year of death and 45% are seen within the month — most for reasons unrelated to suicide or mental health. However, the rate of detecting patients’ suicidal thoughts (also known as suicide ideation) at the point of care is extremely low. The Joint Commission urges clinicians in primary, emergency and behavioral health to implement the following practices:

  1. Review each patient’s personal and family medical history for suicide risk factors.
  2. Screen all patients for suicide ideation, using a brief, standardized evidence-based screening tool.
  3. Review screening questionnaires before the patient leaves the appointment or is discharged.
  4. Use assessment results to inform the level of safety measures needed and take one of the following actions:
    1. Keep patients in acute suicidal crisis in a safe environment under one-on-one observation.
    2. For patients at lower risk, make personal and direct referrals to outpatient behavioral health and other providers within one week of the initial assessment.
    3. For all patients with suicide ideation, give them a number to the National Suicide Prevention Lifeline (800-273-TALK), conduct safety planning and restrict access to lethal means.

Suicidal risk factors are characteristics that make it more likely that an individual will consider, attempt or die by suicide. Clinicians should be familiar with these risk factors and take appropriate steps to ensure patient safety. According to the National Suicide Prevention Lifeline, risk factors include:

  • Depression, schizophrenia, anxiety disorders and certain personality disorders
  • Alcohol and other substance use disorders
  • Impulsive and/or aggressive tendencies
  • History of trauma or abuse
  • Major physical illnesses
  • Previous suicide attempt
  • Family history of suicide
  • Job or financial loss
  • Loss of a relationship
  • Lack of social support

Most people who die by suicide exhibit warning signs. The more signs a person shows, the greater the risk. A change in behavior or the presence of entirely new behaviors, especially those related to a painful event, loss or life change carry the greatest concern. Some signs to look for include:

  • Talking about wanting to die
  • Looking for a way to kill oneself, such as searching online for materials or means
  • Talking about feeling hopeless or having no purpose
  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden
  • Increasing the use of alcohol or drugs
  • Acting anxious, agitated or reckless
  • Sleeping too little or too much
  • Withdrawing from others
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

Need more resources? Standardized screening and assessment tools ensure staff use common language, discuss and understand a patient’s status and make plans for appropriate care. Zero Suicide is a concept and initiative founded on the belief that suicide deaths for individuals under care within health and behavioral health systems are preventable. It is supported by the National Action Alliance for Suicide Prevention, Suicide Prevention Resource Center (SPRC) and the Substance Abuse and Mental Health Services Administration (SAMHSA). The Zero Suicide website lists a number of tools available for different organizations and settings based, in part, on whether the organization will provide comprehensive care after a patient is found to be at risk.

Suicide risk is highest within the month immediately following discharge from an emergency department or psychiatric hospital, with the greatest number of suicides occurring within one week of discharge. If a patient is NOT considered to be in imminent risk for suicide, but is in need of further evaluation, effective strategies to assist individuals in connecting with outpatient services and providing support during this high-risk time are critical. According to SPRC, these include:

  • Making a follow-up appointment for the patient before discharge (ideally within 48 hours)
  • Involving family, friends and other loved ones in the care transition plan
  • Making follow-up contacts with the patient and checking with providers to make sure the person is receiving follow-up care
  • Developing agreements among hospitals, behavioral health providers, crisis centers and others to facilitate safe transitions between settings
  • Transmitting patient health information to referral providers in a timely manner

If a patient is in imminent risk for suicide, secure the environment and facilitate rapid psychological evaluation and treatment. The safest environment is a room or unit designated for behavioral health patients. If not available, or until available:

  • Ensure there is one-to-one constant staff observation and/or security.
  • Assess the area for items that might increase the risk of suicide by hanging, such as door hinges, plumbing fixtures, privacy partitions, clothing hooks and closet or curtain rods.
  • Eliminate, to the extent possible, all means of hanging such as sheets, pants, belts, shoelaces, cords, electronic equipment and curtains or blinds.
  • Use plastic utensils and disposable dishes for meals.
  • Minimize access to glass and framed artwork.
  • Eliminate materials that present a smothering hazard, such as plastic shower curtains, trash liners and disposable gloves.
  • Prevent elopement. Assign the patient to a room that allows easy observation and access for staff, yet away from exits. Keep patient attire limited to a hospital gown.
  • Check for the presence of weapons, medications and any other items that can be used for self-harm. Organizational policies may require a search of personal belongings to be witnessed by or delegated to designated staff, such as security personnel. Any potentially harmful items should be documented and secured away from the patient.

Top 10 List

As a family member, friend, co-worker or neighbor, you may be in the best position to detect risk factors and warning signs for suicide in others. If you think someone may be at risk, there are several important things you should do:

  1. Be brave and direct — ask if they have thoughts about suicide. Asking will not give someone new ideas.
  2. Do not act shocked or surprised by the answer, which could cause them to draw away from you.
  3. Keep talking to them and ask how you can help.
  4. Offer hope and let them know alternatives are available. Do not offer glib reassurance; it only proves you don’t understand.
  5. Be available. Show interest and support. If you cannot do this, find someone who can.
  6. Ask about access to guns and other means to cause death.
  7. Ask about plans they have to die. The more detail, the higher the risk.
  8. Take action — remove guns and other means to cause death.
  9. Do not keep the information secret! Get help from persons or agencies that specialize in crisis intervention.
  10. Call a crisis hotline in your area or 1-800-273-TALK (8255), a family physician, a psychiatrist, a medical emergency room or a community mental health center. Do not try to do deal with the situation by yourself.

Recommended Readings


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See how well you score on these true/false questions about suicide. Click each statement to learn the answer.

Source: American Foundation for Suicide Prevention and the CDC: National Suicide Statistics


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Most suicide attempts fail.

Answer: True – For every 10 to 25 suicide attempts, 1 actually results in death.

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Poisoning is the most common method for attempted suicide in women.

Answer: True – Three times as many women attempt suicide than men, while four times as many men than women actually kill themselves. Poisoning is the most common means for women — typically an overdose of medication, the result of which is less often lethal. Firearms are the most common method for men.

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Suicides happen without warning

False – Most suicidal individuals give definite warning signs of their intentions, but many people are either unaware of the significance of the warnings or do not know how to respond to them. Most teens that attempt or die by suicide have communicated their distress or plans to at least one other person. These communications are not always direct, so it is important to know some of the key warning signs.

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Teens and adults cope with difficult life events in the same ways.

False – Problems that may seem like a big deal to one person, particularly adults, may be causing a great deal of distress for the suicidal teen. It is important to remember that perceived crises can be just as concerning and predictive of suicidal behavior as actual crises.

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Everyone has the potential for suicide.

True – Suicidal ideations can affect individuals of all genders, races, ethnicities, upbringings and socio-economic statuses. Pay attention to what a person says and does, not what he or she looks like or how you believe the person should think, feel or act.

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Teens have the highest suicide rate of all age groups.

False – Teenage suicides make headlines, but the elderly are more likely to take their own lives than any other age group.

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Depression is the most common diagnosis associated with suicide.

True – Those with depression are 20 times more likely to die by suicide than the general population.

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Poor countries have higher suicide rates.

False –Richer countries such as Japan and France have some of the highest suicide rates. Suicide hotlines are seldom used.

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Suicide hotlines are seldom used.

False – Increased publicity has increased the use of suicide hotlines in recent years.

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If a patient screens positive for suicide ideation but refuses further evaluation or treatment, healthcare personnel are prohibited from discussing that information with anyone else.

False – HIPAA permits contact to family, friends or outpatient treatment providers when the clinician, in good faith, believes the patient may be a danger to him or herself or others. First, request the patient’s permission. If the patient declines to consent after reasonable attempts have been made to request permission, there are circumstances in which contact may be made without the patient’s permission.

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