D.9 MCM 658-116A-10 Telephone Calls - Suicide or Homicide.pdf

Department of Veterans Affairs VAMC MEMORANDUM 658-116A-10 VA Medical Center March 8, 2018 Salem, VA 24153 Telephone Calls – Suicide or Homicide

TELEPHONE CALLS – SUICIDE OR HOMICIDE

PURPOSE: To outline the procedures to be followed in the event a Veteran patient calls the medical center or a Community Based Outpatient Clinic (CBOC) threatening suicide or homicide, or in the event a family member, significant other, or another interested party (e.g., friend, neighbor) calls to report a Veteran’s intent to commit suicide or homicide.

POLICY: It is the policy of this medical center that telephone calls regarding planned or potential suicide or homicide will be handled in an appropriate and consistent fashion by all medical center and CBOC staff. Toward this end, all medical center and CBOC employees are expected to complete the required annual training on this topic and familiarize themselves with the procedures outlined in this policy. It is also expected that all staff will act in accordance with this training and policy, and avoid any independent interventions or initiatives.

RESPONSIBILITIES:

a. Service/service line chiefs are responsible for ensuring that all staff under their direction completes the required annual Talent Management System (TMS) training entitled “Suicide/Homicide Telephone Calls”.

b. All employees are responsible for completing the annual TMS training entitled “Suicide/Homicide Telephone Calls” and should also be aware of the procedures outlined in this policy in order to effectively respond to situations where telephone calls involve threats of suicide or homicide.

ACTION:

a. When telephone calls threatening suicide or homicide are received during regular working hours (7:45 a.m. - 4:30 p.m. Monday through Friday), the procedures outlined below should be followed.

(1) If a Veteran patient calls the medical center or CBOC threatening to commit suicide or homicide, the staff member taking the telephone call should attempt to identify the caller and his/her relationship (past or present) to this medical center and/or CBOC and the Department of Veterans Affairs (DVA), retrieve the telephone number from which the Veteran is calling, and the Veteran's physical location at the time of the call.

(2) The staff member taking the call should remain on the line with the Veteran while alerting a coworker through email or other means to provide assistance;

however, if the staff member receiving the call is the Veteran's mental health provider or clinical treatment team member, notification of a coworker is not required unless immediate safety concerns are present (see 4.a.8 below).

D.9 MCM 658-116A-10 Telephone Calls - Suicide or Homicide 36C24621R0068

Salem, VA 24153 Telephone Calls – Suicide or Homicide

(3) For calls received by other medical center staff (i.e., someone other than the Veteran’s mental health provider or a member of the Veteran’s clinical treatment team), the coworker notified to assist should attempt to identify and contact the Veteran’s mental health provider. However, if this is not practical or timely, the PCMHI team or the crisis intervention psychiatrist is available. The numbers for these are pager 1819 (PCMHI) or pager 1221 (crisis intervention psychiatrist).

Extensions are 3757 for PCMHI and 3266 for crisis intervention. After hours, contact 2173 (AOD) or operator for contacting the mental health on-call provider.

The coworker may also contact the mental health office at 2515 for assistance.

In summary contact:

Mental Health Provider if known

Pager 1819 for PCMHI

Extension 3266 for ED Crisis Intervention

Extension 2515 for Chief, Mental Health Office

(4) In all cases, staff should try to ensure a “warm handoff” to the mental health provider responding to the request for assistance, i.e., the provider should come to the location of the call rather than the call being transferred to the provider unless this is not practical and/or would unnecessarily delay involvement of the mental health provider.

(5) For calls received at CBOC sites, the coworker notified to assist with managing the call will contact an appropriate clinical staff person (psychiatrist, psychologist, social worker) at the CBOC to assist with responding to the call.

The staff member handling the call should try to ensure a “warm handoff” to the mental health provider responding to the request for assistance, , i.e., the provider should come to the location of the call rather than the call being transferred to the provider unless this is not practical and/or would unnecessarily delay involvement of the mental health provider. In the event an appropriate clinical staff person is unavailable at the CBOC, the coworker may contact the medical center’s Suicide Prevention Coordinator at (540) 982-2463, extension 2512 or cellphone (540) 682-6375 or the Suicide Prevention Case Manager at (540) 982-2463, extension 2436 or cellphone (540) 589-1192 for assistance. If the coworker is unable to contact either the Suicide Prevention Coordinator or the Suicide Prevention Case Manager, he/she may contact the office of the Chief, MHSL at (540) 982-2463, extension 2516 for assistance.

(6) While waiting for the mental health provider to assist with the call, the staff member who is on the telephone with the Veteran should gather as much information as possible, including:

name of the caller;

street address/physical location of the caller;

telephone number being used by the caller;

whether the caller is treated at the Salem Veterans Affairs Medical

Center (VAMC);

whether the caller is alone or with others;

whether the caller has a plan to harm self or others;

whether the caller has ready access to a means of carrying out a plan

(e.g., firearms, other weapons, medications);

whether the caller seems to be intoxicated or currently using alcohol and/or drugs.

(7) Upon arriving at the site of the call (or upon transfer of the call if a “warm handoff” is not practical and/or would unnecessarily delay involvement of the mental health provider), the designated mental health provider will take over the telephone call after the employee who is on the telephone with the Veteran provides a brief introduction to the caller.

(8) If, at any time during the call, there is an indication the Veteran presents an immediate danger to self or others, the staff person on the telephone with the Veteran should notify a coworker and provide the Veteran’s name, telephone number, street address or physical location, and brief call details. The coworker will use this information to take appropriate actions as described in 4.a.9 - 4.a.12 below.

(9) In situations where the Veteran presents an immediate danger to self, the local police in the Veteran’s jurisdiction should be contacted with a request for a wellness check. This request can be initiated by the person initially receiving the call, the coworker who is assisting, or the Veteran’s mental health provider (i.e., it is not necessary to route this request through the Veterans Affairs Police;

however, the Veterans Affairs Police should be notified that the local police have been contacted). The following numbers can be used to request a wellness check when a Veteran is presenting as an immediate danger to self:

Roanoke City: (540) 853-2212

Roanoke County: (540) 562-3265

Salem City: (540) 375-3078

Botetourt: (540) 473-8230

Franklin County (Rocky Mount): (540) 483-8830

Christiansburg: (540) 382-3131

Blacksburg: (540) 961-1150

Danville: (434) 799-5111

Martinsville: (276) 403-5300

(10) Once the local authorities have been contacted with a request for a wellness check, the staff member initiating the request will send an encrypted message via Outlook to the medical center’s Privacy Officer with a brief description of the incident that includes the name of the Veteran, the last four digits of the Veteran’s social security number, the date and time of the incident, the nature of the threat/danger that warranted the request for a wellness check, and the name of the law enforcement agency that was contacted.

(11) The staff member initiating the request for a wellness check will follow up with the police agency conducting the wellness check to determine the outcome of the check (e.g., Veteran found to be safe, Veteran taken to nearest emergency department for evaluation).

(12) In situations where the Veteran presents an immediate danger to others and the call is received at the medical center, the coworker will call the Veterans Affairs Police at extension 2224 or 1222, provide the police dispatcher with the call details, and request a wellness check be initiated by the police. The Veterans Affairs Police will request the police agency nearest the Veteran's location to make personal contact with the Veteran and determine whether there is a need for an emergency mental health evaluation. Once this has been accomplished, the Veterans Affairs Police dispatcher will send an encrypted message via Outlook to the medical center’s Privacy Officer with a brief description of the incident that includes the name of the Veteran, the last four digits of the Veteran’s social security number, the date and time of the incident, the nature of the threat/danger that warranted the request for a wellness check, and the name of the law enforcement agency that was contacted. The Veterans Affairs Police will follow up with the police agency conducting the wellness check to determine the outcome of the check (e.g., Veteran found to be safe, Veteran taken to nearest emergency department for evaluation).

(13) If the call is received at a CBOC and there is an indication the Veteran presents an immediate danger to self or others, the coworker notified to assist with responding to the call will contact the local police department to request a wellness check.

(14) Once the local authorities have been contacted with a request for a wellness check, the CBOC staff member initiating the request will send an encrypted message via Outlook to the medical center’s Privacy Officer with a brief description of the incident that includes the name of the Veteran, the last four digits of the Veteran’s social security number, the date and time of the incident, the nature of the threat/danger that warranted the request for a wellness check, and the name of the law enforcement agency that was contacted.

(15) The CBOC staff member initiating the request for a wellness check will follow up with the police agency conducting the wellness check to determine the outcome of the check (e.g., Veteran found to be safe, Veteran taken to nearest emergency department for evaluation).

(16) If a Veteran’s family member, significant other, or another interested party (e.g., friend, neighbor) calls the medical center or a CBOC to report a Veteran’s intent to harm himself/herself or someone else, the caller should be encouraged to contact their local police or the local magistrate for an emergency custody order and/or take the Veteran to the medical center or the nearest emergency department, if safe to do so. If the Veteran is available and willing, phone contact between the Veteran and an appropriate clinical provider or treatment team member will be facilitated by the person receiving the call. This should be done by following procedures outlined above (4.a.1-7). If there is any indication of immediate danger to either the Veteran or others during the call, refer to the instructions provided in 4.a.8-15 above.

(17) The staff member who initially receives a telephone call regarding planned or potential suicide or homicide (from a Veteran, family member, significant other, or another interested party) should initiate a Report of Contact (VAF 119) that describes the contact with the caller. In addition, if a wellness check was requested, the Report of Contact should include which police agency was contacted (either the Veterans Affairs Police or the specific local police agency) and the outcomes of the wellness check. This information should be shared with the clinical staff person handling the call and with the medical center’s Suicide Prevention Coordinator.

b. When telephone calls threatening suicide or homicide are received outside of regular working hours, the procedures outlined below should be followed.

(1) If a Veteran patient calls the medical center outside of regular working hours threatening to commit suicide or homicide, the staff member taking the telephone call should attempt to identify the caller and his/her relationship (past or present) to the DVA and this medical center, the telephone number from which the Veteran is calling, and the Veteran's physical location at the time of the call.

(2) The staff member should remain on the line with the Veteran and ask the Veteran to come to the medical center or go to the nearest emergency department, if safe to do so. If the Veteran is unwilling or unable to come to the medical center or go to the nearest emergency room (e.g., in acute physical or psychiatric distress, intoxicated, transportation issues), the staff member taking the call should alert a coworker through email or other means to provide assistance.

(3) The coworker should then contact the Administrative Officer of the Day (AOD) and request that the on-call psychiatrist, on-call resident, or physician assistant assigned to MHSL be contacted to assist with responding to the call.

The staff person initially receiving the call should continue to talk with the caller while the AOD contacts the clinical provider.

(4) Staff should try to ensure a “warm handoff” to the clinical provider responding to the request for assistance, i.e., the provider should come to the location of the call rather than the call being transferred to the provider unless this is not practical and/or would unnecessarily delay involvement of the clinical provider.

(5) While waiting for the clinical provider to assist with the call, the staff member who is on the telephone with the Veteran should gather as much information as possible, including:

name of the caller;

street address/physical location of the caller;

telephone number being used by the caller;

whether the caller is treated at the Salem Veterans Affairs Medical

Center (VAMC);

whether the caller is alone or with others;

whether the caller has a plan to harm self or others;

whether the caller has ready access to a means of carrying out a plan

(e.g., firearms, other weapons, medications);

whether the caller seems to be intoxicated or currently using alcohol and/or drugs.

(6) Upon arriving at the site of the call (or upon transfer of the call if a “warm handoff” is not practical and/or would unnecessarily delay involvement of the clinical provider), the on-call psychiatrist, on-call resident, or physician assistant assigned to MHSL will take over the telephone call after the employee who is on the telephone with the Veteran provides a brief introduction to the caller.

(7) If, at any time during the call, there is an indication the Veteran presents an immediate danger to self or others, the staff person on the telephone with the Veteran should notify a coworker, providing name, telephone number, street address/physical location, and brief call details. The coworker will use this information to take appropriate actions as described in 4.b.8 - 4.b.10 below.

(8) In situations where the Veteran presents an immediate danger to self, the local police in the Veteran’s jurisdiction should be contacted with a request for a wellness check. This request can be initiated by the person initially receiving the call, the coworker who is assisting, or the clinical provider who responds to the request for assistance (i.e., it is not necessary to route this request through the Veterans Affairs Police; however, the Veterans Affairs Police should always be notified that the local police have been contacted). The following numbers can be used to request a wellness check when a Veteran is presenting as an immediate danger to self:

Roanoke City: (540) 853-2212 Roanoke County: (540) 562-3265 Salem City: (540) 375-3078 Botetourt: (540) 473-8230 Franklin County (Rocky Mount): (540) 483-8830 Christiansburg: (540) 382-3131 Blacksburg: (540) 961-1150 Danville: (434) 799-5111

Martinsville: (276) 403-5300

(9) Once the local authorities have been contacted with a request for a wellness check, the staff member initiating the request will send an encrypted message via Outlook to the medical center’s Privacy Officer with a brief description of the incident that includes the name of the Veteran, the last four digits of the Veteran’s social security number, the date and time of the incident, the nature of the threat/danger that warranted the request for a wellness check, and the name of the law enforcement agency that was contacted.

(10) The staff member initiating the request for a wellness check will follow up with the police agency conducting the wellness check to determine the outcome of the check (e.g., Veteran found to be safe, Veteran taken to nearest emergency department for evaluation).

(11) In situations where the Veteran presents an immediate danger to others, the coworker will call the Veterans Affairs Police at extension 2224 or 1222, provide the police dispatcher with call details, and request a wellness check be initiated by the police. The Veterans Affairs Police will request the police agency nearest the Veteran's location to make personal contact with the Veteran and determine whether there is a need for an emergency mental health evaluation. Once this has been accomplished, the Veterans Affairs Police dispatcher will send an encrypted message via Outlook to the medical center’s Privacy Officer with a brief description of the incident that includes the name of the Veteran, the last four digits of the Veteran’s social security number, the date and time of the incident, the nature of the threat/danger that warranted the request for a wellness check, and the name of the law enforcement agency that was contacted. The Veterans Affairs Police will follow up with the police agency conducting the wellness check to determine the outcome of the check (e.g., Veteran found to be safe, Veteran taken to nearest emergency department for evaluation).

(12) If a Veteran’s family member, significant other, or another interested party (e.g., friend, neighbor) calls the medical center to report a Veteran’s intent to harm himself/herself or someone else, the caller should be encouraged to contact their local police or the local magistrate for an emergency custody order and/or take the Veteran to the either the medical center or the nearest emergency department, if safe to do so. If the Veteran is available and willing, phone contact between the Veteran and a clinical provider (on-call psychiatrist, on-call resident, or physician assistant assigned to MHSL) will be facilitated by the person receiving the call.

This should be done by following procedures outlined above (4.b.1-6). If there is any indication of immediate danger to either the Veteran or others during the call, refer to the instructions provided in 4.b.7-11 above.

(13) The staff member who initially receives a telephone call regarding planned or potential suicide or homicide (from a Veteran, family member, significant other, or another interested party) should initiate a Report of Contact (VAF 119) that describes their contact with the caller. In addition, if a wellness check was requested, the Report of Contact should include which police agency was contacted (either the Veterans Affairs Police or the specific local police agency) and the outcomes of the wellness check. This information should be shared with the clinical staff person handling the call and with the medical center’s Suicide Prevention Coordinator.

(14) The clinical provider assisting with the call (on-call psychiatrist, on-call resident, or physician assistant assigned to MHSL) will communicate the situation and the relevant outcomes to the AOD for appropriate action.

c. Telephone Messaging System. Mental health staff at the medical center and CBOCs will include on their outgoing voicemail messaging system (on both desk phones and VA-issued cell phones) instructions for how a caller can make emergency contact with either 911 or the Veteran’s Crisis Line for immediate crisis management assistance. The voicemail message should include the following standard elements:

“Hello. You have reached the phone of (insert name and title). If you are having a medical or mental health emergency, hang up and dial 911. If you are having thoughts of suicide, please hang up and call 1-800-273-8255, then press 1 at the prompt to reach the Veterans Crisis Line. That number again is 1, 800, two, seven, three, eight, two, five, five, and then press 1 for the Veterans Crisis Line.

Otherwise, please leave a brief message and I will return your call when I am able during regular business hours.”

ETHICAL DOMAIN:

a. Shared Decision Making with Patients

b. Professionalism in Patient Care

REFERENCES: None.

FOLLOW-UP RESPONSIBILITY: Chief, Mental Health Service Line.

RESCISSION: Medical Center Memorandum 658-116A-10, “Telephone Calls – Suicide or Homicide,” December 18, 2015.

EXPIRATION: March 8, 2021.

Rebecca J. Stackhouse, CTRS, FACHE

Medical Center Director