Resources: Suicide & Self-Harm/Injury (Assessment, Treatment & Prevention)
Relevant Standards
- CMS: A-0143 [§482.13(c)(1) – Death Records], B139 [Active Treatment & harm to self]
- TJC: NPSG.15.01.01 [Identify patients at risk for suicide]
References & Tools
- Suicide Risk Assessment<1210>:
- APA: Assessing and Treating Suicidal Behaviors: A Quick Reference Guideiline1210
- Suicide Assessment Part 1 & 2: Case Approach(PDF-Ftxt) (Psychiatric Times. Vol. 26 No. 12 December 3, 2009)
- Scales:
- Suicide Intent Scale {Short Version}
- Chronological Assessment of Suicide Events (CASE Approach)
- SAD PERSONS Scale (PDF)/[HTML] – SAD PERSONS w/scoring (DOC)[HTML]
- Suicide Assessment Five-step Evaluation and Triage (SAFE-T PDF)[SAFE-T HTML] [Contrib by V. Knight, RN, PhD]
- Basic Suicide Assessment Five-step Evaluation (B-SAFE) (B-SAFE PDF) [B-SAFE HTML] [Contrib by V. Knight, RN, PhD]
- Suicide Intent Scale {Short Version}
- Assessment and Interventions with Potentially Suicidal Patients: A Pocket Guide…1011 (PDF)[HTML] [Contrib by V. Knight, RN, PhD]
- Assessment and Assignment of Suicide Risk (PDF), [HTML] Prepared by: Douglas Jacobs, MD – CEO & Pres of Screening for Mental Health, Inc.
- Suicide Prevention & Intervention <1210>:
- Samaritans Guide to Suicide Prevention Materials and Resources [Samaritans HTML]
- The epidemiology and prevention of suicide by hanging: A systematic review. Int J Epidemiol 34:433–442, 2005) by Gunnell D., et al., (Gunnell Ftxt PDF) [Gunnell Ftxt HTML]
- NASMHPD: Suicide Prevention Efforts for Individuals with Serious Mental Illness: Roles for the State Mental Health Authority NASMHPD Medical Directors Council Technical Report (NASMHPD-HTML)
- SAMHSA: National Strategy for Suicide Prevention Resources & Publications
- Suicide Prevention Resource Center (SPRC)
- The National Suicide Prevention Lifeline [Lifeline – HTML] 1-800-273-TALK (8255)
- a network of 162 crisis centers in 50 states providing 24-hour, toll-free suicide prevention service available to anyone in suicidal crisis.
- Hotline 1-800-273-TALK (8255) and Chat Support available
- Make staff aware (especially SW) and include in Pt/Family discharge information for pts at risk/with relevant past history. Booklets available.
- a network of 162 crisis centers in 50 states providing 24-hour, toll-free suicide prevention service available to anyone in suicidal crisis.
- Suicide in secure psychiatric facilities – By Gordon H.: Advances in Psychiatric Treatment 8:408–417, 2002. contains useful lists of risk factors for various psychiatric illnesses and hospital settings [Gordon – HTML]
- Samaritans Guide to Suicide Prevention Materials and Resources [Samaritans HTML]
- APA: Assessing and Treating Suicidal Behaviors: A Quick Reference Guideiline1210
- Nursing Made Incredibly Easy: Assessing Suicide (PDF) – May/June 2008 Pag 46-53 {Full Text PDF1008} Nursing CE available with this article until June 30, 2010
- American Society of Health-System Pharmacists: Drugs Associated with Suicidality
- Suicide Prevention Organizations
- Active Minds
- American Foundation for Suicide Prevention (AFSP) (Includes Support Group Directory)
- The American Association of Suicidology
- The Jed Foundation
- National Alliance on Mental Illness (NAMI)
- The National Association of State Mental Health Program Directors
- Mental Health America
- National Organization for People of Color Against Suicide (NOPCAS)
- Substance Abuse and Mental Health Services Administration (SAMHSA)
- SAMHSA’s National Mental Health Information Center
- SAVE – Suicide Awareness Voices of Education
- Suicide Prevention Action Network USA
- Suicide Prevention Resource Center
- The Trevor Project
- Yellow Ribbon Suicide Prevention Program (Includes Ask 4 Help Card)
- Self-Harm/Self-Injury (as distinct from Suicide)<1303>:
- Self-Injury: A Recovery & Evidence Based Toolkit ®- Good overview with references
- Measuring Self-Harm Behavior with the Self-Harm Inventory ®- Includes brief overview of multiple tools and sample self-assessment questionnaire
- Clinical Assessment of Self-Injury: A practical Guide, ®Journal Of Clinical Psychology: In Session, Vol. 63(11), 1057–1068 (2007)
- Self-Injury Screening Questionnaire (ICG) ®- Self-assessment questionnaire
- Self Harm Risk Rating Scale (SHARS) ®- rate-able self-assessment questionnaire
- Inventory Of Statements About Self-Injury (Isas) ®- More indepth Self-assessment questionnaire
- Nice Pathways: Self-Harm Overview
- Environmental Suicide-Related Assessment
- Mental Health Environment of Care Checklist (MHEOCC – XLS)[®][MHEOCC – HTML] – Used in all VA mental health units since October 2007. This is an outgrowth of the Veterans Affairs Patient Safety Workgroup whose Root Cause Analysis Database revealed that approximately 70% of VA suicides/attempted suicides were either hangings, cutting with a sharp object or drug overdoses, with hanging the largest category. Virtually all of the hangings used some environmental anchor that could be modified to reduce the risk of harm; and 39% of the cutting incidents used razor blades. Ergo this checklist. [Original Contrib by V. Knight, RN, PHD] #MHEOCC
- VA Environmental Programs Service Mental Health Guide (v11, 2014) – recommended products, solutions and ideas for use in Inpatient Mental Health areas (including both positive and cautionary attributes to consider before purchase) to ensure safe, and therapeutically enriching environment.
- NAPHS: Design Guide for the Built Environment of Behavioral Health Facilities 6.2 (April 2014) (PDF)[®] the “bible for in-room furnishings that help prevent suicide” by David M. Sine, ARM, CSP, CPHRM and James M. Hunt, AIA
- Dean’s 7 Step Risk Assessment per JCAHO by Dean Samet (Samet – PDF)
- Behavioral Health Risk Assessment 2009 (BHRA-PDF)
- Suicide Prevention and the Inpatient Room: Bricks and Sticks and Beyond EC News, Dec ’08, Pg08-[••REF••] (InPtRm-FtxtPDF),[InPtRm-HTML]
- Mental Health Environment of Care Checklist (MHEOCC – XLS)[®][MHEOCC – HTML] – Used in all VA mental health units since October 2007. This is an outgrowth of the Veterans Affairs Patient Safety Workgroup whose Root Cause Analysis Database revealed that approximately 70% of VA suicides/attempted suicides were either hangings, cutting with a sharp object or drug overdoses, with hanging the largest category. Virtually all of the hangings used some environmental anchor that could be modified to reduce the risk of harm; and 39% of the cutting incidents used razor blades. Ergo this checklist. [Original Contrib by V. Knight, RN, PHD] #MHEOCC
Required Written Documents
- NPSG.15.01.01, EP 1 (a risk assessment that identifies specific patient
characteristics and environmental features that may increase
or decrease the risk for suicide.) - Sample:
** Additional Clarifications & Compliance Strategies (Premier)**
[private Membership premier]
- Standards BoosterPak™ Suicide Risk (NPSG.15.01.01) (June 2011)… goto your TJC Intranet
- Sentinel Event Alert, Issue 46: A follow-up report on preventing suicide: Focus on medical/surgical units and the emergency department (Nov 17, 2010)
- Sentinel Event Alert, Issue 7: Inpatient Suicides: Recommendations for Prevention (Nov 6, 1998)
- Full Text (Ftxt) Articles from TJC/JCR:
- Ftxt: A Checklist to Identify Inpatient Suicide Hazards in Veterans Affairs Hospitals, Peter D. Mills, Ph.D., M.S.; … The Joint Commission Journal on Quality and Patient Safety, February 2010, Volume 36, Number 2
- Ftxt: Assessing Patients’ Potential Suicide Risk, The Joint Commission Perspectives on Patient Safety, April 2009, Volume 9, Issue 4. Includes reference to the CDC’s Violence Prevention section (includes suicide) of their National Center for Injury Prevention. [Pearl] StEd and PtEd may want to take advantage of their 2-page fact sheets (e.g., ‘Understanding Suicide and ‘Suicide Facts At A Glance’), podcasts and other free resources are listed there.
- Ftxt: Patient Suicide: Complying with National Patient Safety Goal 15A The Joint Commission Perspectives on Patient Safety, February 2008, Volume 8, Issue 2
- Suicide Prevention and the Inpatient Room: Bricks and Sticks and Beyond [HTML] ® EC News, Dec ’08, Pg08
- Ftxt: CASE STUDY: Creating a Suicide Risk Management Program: Teaching all staff members to address suicide risk, Joint Commission Perspectives on Patient Safety, November 2006, Volume 6, Issue 11
- Ftxt: Training Staff to Reduce the Risk of Suicide Joint Commission: The Source, March 2005, Volume 3, Issue 3
- Perspectives on Patient Safety, Vol 6, # 8: Reducing the Risk of Suicide: Meeting National Patient Safety Goal 15A Source: August 2006, pp. 5-15(11)
- EC News Vol9,#10: Reducing the Risk of Suicide: Using Environmental Controls to Help Support Suicide Prevention Efforts, October 2006, pp. 4-5(2)
- EC News Vol9,#6: Using Risk Assessment: Where Standards Are Silent, Proactive Process Can Provide Clarity: June 2006, Pg1
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