D.23 NMVAHCS SOP Identification and Care of Patients at High Risk for Suicide.pdf

New Mexico VA Healthcare System: Suicide Prevention Team

Standard Operating Procedure: Identification and Care of Patients at High Risk for

Suicide

Date of Issue: 2/13/2020

Author: Brenda Mayne, PhD, Suicide Prevention Coordinator

Approving Official: Lorraine Torres-Sena, Ph.D., Director of Behavioral Health Care Line

1. Identification

a. Veterans at heightened risk of suicide are identified as veterans admitted to inpatient units for suicide attempts or acute suicidal ideation as well as veterans reporting suicide attempts in the last 90 days. Other veterans may be determined to be at heightened risk of suicide after evaluation by licensed clinicians.

b. Staff receiving reports of any suicide attempt by a veteran will complete a Suicide

Behavior Report which is templated as a clinical note title in CPRS. Suicide Behavior

Reports are view alerted to all members the Suicide Prevention Team.

c. Suicide Prevention staff will review admissions to Inpatient Psychiatry to identify veterans admitted for acute suicidal ideation.

d. Medical staff notify Psychiatry Consultation and Liaison when veterans are admitted to medical units with acute suicidal ideation. Psychiatry Consultation and Liaison notifies Suicide Prevention staff of these veterans who are at heightened risk of suicide via Communication Note or by co-signing Suicide Prevention staff on the clinical note.

e. Outpatient staff who assess a veteran as being at heightened risk of suicide due to suicidal ideation notify Suicide Prevention staff via Communication Note or by co-signing Suicide Prevention staff on the clinical note.

2. Flagging of Veterans at Heightened Risk of Suicide

Suicide Prevention staff place a behavioral flag on the charts of veterans identified as being at heightened risk of suicide. The flag text describes the reason for flagging and instructs providers as to suggested treatment considerations.

3. Out Patient Care of Veterans at Heightened Risk for Suicide.

a. Veterans identified as being at heightened risk for suicide are to be scheduled with a mental health provider for weekly appointments for at least one month after being identified as such or after discharge if the veteran was identified while inpatient.

4. Suicide Safety Plans

Veterans identified as having heightened risk for suicide will complete a Suicide Safety

Plan.

a. Inpatient Psychiatry staff assist identified high risk veterans complete the Suicide

Safety Plan prior to discharge and provide the veterans with paper copies of their completed plans.

b. Veterans identified as being heightened risk for suicide on other medical units or in outpatient clinics will complete the Suicide Safety Plan with their assigned mental health provider within the next two scheduled visits.

5. Risk Assessment

Veterans identified as being at heightened risk for suicide should be assessed for suicidality at every clinical visit other than educational groups. This may be documented in the clinical note or by using the facility templated Suicide Risk Assessment.

6. Assessment and Documentation of Firearm Access

a. Veterans identified as being at heightened risk for suicide will be asked if they have access to firearms. When firearms are available to such veterans, means restriction will be discussed and documented in the Suicide Safety Plan.

b. Veterans identified as being at heightened risk for suicide on Inpatient Psychiatry will be assessed for access to firearms by resident psychiatrists and the unit social workers. Assessment positive for firearm access will include contact with the veteran’s family members and social network to discuss reduction of access to firearms.

7. Discharge Planning for High Risk Veterans moving from Inpatient Psychiatry to

Outpatient care

a. Social Workers on Inpatient Psychiatry, in addition to scheduling follow-up appointments in appropriate medical and BHCL clinics, notify the Suicide Prevention team of the veterans’ discharge date.

b. Veterans at heightened risk of suicide who do not have established mental health care or who are waiting for appointments with BHCL will be scheduled with Suicide

Prevention for weekly contacts for at least one month after discharge.

Brenda Mayne, Ph.D. Date

Suicide Prevention Coordinator

Lorraine Torres-Sena, Ph.D. Date

Director, BHCL