Hospital Protocol: Suicide Attempts And Family Notification

If someone is attempting suicide or about to attempt suicide, it is important to call 911 immediately. The emergency room in a hospital can be an option for those seeking immediate support. Once the patient has been medically stabilized, the next steps involve a mental health evaluation, which generally takes the form of a suicide assessment. The patient's history and circumstances of the attempt are then assessed, along with the likelihood of recurrence. The patient may be involuntarily hospitalized if they refuse evaluation or their insurance plan declines referral. The patient's family may be involved in their care plan, which could include returning to the hospital for outpatient visits or working with a mental health professional.

The patient's family is informed to remove firearms from the patient's home

When a patient is admitted to hospital following a suicide attempt, the priority is to stabilise them and ensure their medical safety. Once this is achieved, doctors will assess the patient's history and circumstances of the attempt, including their likelihood of attempting suicide again. Doctors will also perform a physical examination and evaluate the patient's mental status.

As part of this evaluation, the physician will ask about the availability of firearms, medications, and other means of suicide. Given that handguns are commonly used in suicides, accounting for 62% of suicides among men and 39% among women, it is crucial to ensure that guns are inaccessible to the patient upon their return home. To that end, the patient's family may be informed and asked to remove all firearms from the patient's home.

In addition to removing firearms, the patient's family can play a crucial role in their recovery. They can support the patient by accompanying them to healthcare appointments and other places they find stressful. Family members can also help by encouraging the patient to stay away from alcohol and other drugs and by keeping a copy of the patient's safety plan, if they have one.

It is important to remember that each person's journey to healing is unique, and there is no one-size-fits-all approach. The patient may need time to process what has happened and should only share what they are comfortable with. Support groups, therapists, and other mental health professionals can also provide valuable assistance during this challenging time.

The patient is involuntarily hospitalized if they refuse evaluation or their insurance declines referral

When a patient has attempted suicide, the first priority of the physician is to stabilise the patient and ensure their medical safety. Once this is achieved, the physician can assess the patient's history, circumstances of the attempt, and the likelihood of recurrence. The physician-patient relationship is critical to preventing future suicide attempts. A treatment plan should be formulated, which includes an evaluation by a psychiatrist, preferably while the patient is still in the hospital.

If a patient refuses evaluation or their insurance declines referral, the patient should be involuntarily hospitalised. In such cases, the police will escort the patient to a psychiatric facility. This is because suicide is against the law. Once the patient is stable, the physician should ask about and document the availability of firearms, lethal medications, or other means of suicide. Given that handguns are commonly used in suicides, steps must be taken to make guns inaccessible to the patient. This may involve asking a friend or family member to remove all firearms from the patient's home and informing the patient's close contacts to do the same.

Involuntary hospitalisation is a last resort, and physicians should make every effort to encourage patients to comply with evaluations and referrals. This may involve educating the patient about their treatment options and subtly inculcating hope. The physician should also evaluate the patient's problem-solving and coping skills and identify stressors and support systems. The patient's support system may include their family, who can monitor the patient and provide support following the acute phase of the suicide attempt.

It is important to note that suicidal patients cannot be discharged from the hospital alone. In rare cases, if the patient is not intoxicated or impulsive, a reliable friend or family member can accompany them from the hospital. However, it is recommended that medical staff or law enforcement assist with transport.

The patient is stabilized and emergency-stabilized before psychiatric hospitalization

When a patient is stabilized on an inpatient basis, it means they are receiving intensive care and constant monitoring. This can be done in an emergency room, hospital, psychiatric hospital, or mental health or addiction rehabilitation facility. Short-term stabilization care can be provided in a variety of facilities, depending on the situation and the patient's needs. In extreme cases, where the patient requires emergency care, this may be done in an emergency room or a psychiatric hospital.

Suicidal behaviors are considered a crisis that requires professional intervention and short-term stabilization. This includes planning for suicide, telling others about plans, or engaging in serious self-harm. In the acute situation, the first priority is to stabilize the patient and ensure their medical safety. Once this is accomplished, the history and circumstances of the attempt can be assessed, along with the likelihood of recurrence.

The management of patients who have attempted suicide often falls to the primary care physician. This includes obtaining a detailed medical history, performing a physical examination, and collecting observational data about the patient's mental status. If the patient refuses evaluation or their insurance plan declines referral, they should be involuntarily hospitalized. The police will escort the patient to a psychiatric facility if necessary.

During the patient's hospitalization, it is important to establish a follow-up plan, including frequent close contacts or visits during the days after the attempt. This is especially important for patients with firearms or potentially lethal medications in their homes. Friends or family members should be asked to remove these items to ensure the patient's safety.

The patient is encouraged to seek support from family and friends

Following a suicide attempt, patients are encouraged to seek support from their family and friends. This can take many forms, and there are many ways that loved ones can help.

Firstly, it is important to recognise that patients may not know what to say to their family and friends following a suicide attempt. They may need time to process what has happened and come to terms with their feelings. They should not feel pressured to share more than they are comfortable with. However, it is important to talk to those they trust and, when ready, let them know what happened and that they need help to stay safe.

Family and friends can provide support by accompanying patients to healthcare appointments or other places they find stressful. They can also help with day-to-day responsibilities, giving the patient time to recover and reflect. It is beneficial to create a support network of loved ones who can provide a sense of community and reduce feelings of isolation. This network can also act as a safety net, helping to recognise risk factors and providing coping strategies.

In addition, family and friends should encourage the patient to seek professional help and support their engagement with mental health services. This may include finding a therapist or mental health professional, joining support groups, or following care plans provided by the hospital. It is also important for loved ones to encourage healthy habits, such as avoiding alcohol and other drugs, which may negatively impact mental health.

Finally, family and friends should be aware of the patient's safety plan and any potential risks in the patient's environment. This may include removing firearms or other lethal means from the patient's home to ensure their safety and support their recovery.

The patient is discharged with a care plan, which may include outpatient visits

When a patient is discharged following a suicide attempt, it is crucial that they leave with a comprehensive care plan to ensure their safety and well-being. This plan may include outpatient visits and ongoing support from healthcare professionals. Here are some key components of such a care plan:

Stabilization and Safety

The first priority, both during hospitalization and after discharge, is to ensure the patient's medical stability and safety. This involves addressing any immediate physical health concerns and creating a safe environment upon discharge. If the patient has access to firearms or potentially lethal medications, steps must be taken to remove these from the patient's vicinity. This may include requesting that a friend or family member secure or remove such items from the patient's home and any other accessible locations.

Psychiatric and Therapeutic Support

The care plan should include referrals to appropriate psychiatric resources, such as mental health crisis centers, outpatient therapy, or support groups. These resources provide ongoing evaluation, therapy, and medication management to address the underlying causes of the patient's suicide attempt and help prevent future attempts.

Follow-up and Close Monitoring

Frequent follow-up contacts or visits are essential in the days and weeks following a patient's discharge. Close monitoring can be achieved through a combination of office visits and brief telephone check-ins. This allows healthcare professionals to assess the patient's progress, identify any new or recurring risk factors, and adjust the treatment plan accordingly.

Family and Social Support

Involving the patient's family and support system can be beneficial. The patient's loved ones can provide emotional support, accompany the patient to healthcare appointments, and assist with adhering to the treatment plan. Additionally, educating the patient's support network about suicide prevention and warning signs can empower them to take proactive measures and recognize when additional help is needed.

Safety Planning and Crisis Resources

As part of the care plan, patients should be encouraged to develop a safety plan, which may include identifying triggers, coping strategies, and a list of crisis resources. This safety plan should be shared with trusted family members or friends, so they know how to respond if the patient experiences suicidal thoughts or behaviours again. Crisis resources can include suicide hotlines, crisis text lines, and local mental health crisis centres.

By implementing a comprehensive care plan that addresses immediate safety concerns, provides ongoing psychiatric support, ensures regular follow-up, engages the patient's support network, and offers crisis resources, healthcare professionals can help reduce the risk of future suicide attempts and promote the patient's long-term recovery and well-being.

Frequently asked questions