Posted: March 14th, 2020
Preventing Suicide in High-Risk Patient Populations
Preventing Suicide in High-Risk Patient Populations
Suicide is a major public health problem that affects millions of people worldwide. According to the World Health Organization, more than 700,000 people died by suicide in 2019, and many more attempted suicide or had suicidal thoughts. Suicide is the fourth leading cause of death among 15-29 year olds, and the second leading cause of death among 15-19 year olds.
Suicide prevention is a complex and multifaceted challenge that requires a comprehensive and coordinated approach from various sectors and stakeholders. One of the key aspects of suicide prevention is identifying and supporting high-risk patient populations, such as people with mental disorders, substance use disorders, chronic physical illnesses, previous suicide attempts, exposure to violence, or social isolation. These groups have a higher risk of suicidal behavior than the general population, and often face multiple barriers to accessing adequate and timely care.
In this blog post, we will discuss some of the evidence-based strategies and interventions that can help prevent suicide in high-risk patient populations, as well as some of the challenges and opportunities for improving suicide prevention efforts in different settings and contexts.
Strategies and Interventions for Suicide Prevention in High-Risk Patient Populations
There is no single solution or intervention that can prevent all suicides, but there are some common elements that can enhance the effectiveness of suicide prevention programs and policies. Some of these elements are:
– Screening and assessment: Screening and assessment tools can help identify high-risk patients who may benefit from further evaluation and intervention. For example, the Patient Health Questionnaire-9 (PHQ-9) is a widely used instrument that can screen for depression and suicidal ideation in primary care settings. The Columbia-Suicide Severity Rating Scale (C-SSRS) is another tool that can assess the severity and frequency of suicidal thoughts and behaviors in various settings. These tools can help clinicians to triage patients according to their level of risk and provide appropriate referrals and follow-up.
– Treatment and management: Treatment and management of the underlying conditions or factors that contribute to suicidal risk are essential for reducing suicidal behavior. For example, psychotherapy, such as cognitive-behavioral therapy (CBT) or dialectical behavior therapy (DBT), can help patients cope with negative emotions, challenge distorted thoughts, and develop problem-solving and emotion-regulation skills. Pharmacotherapy, such as antidepressants or mood stabilizers, can help patients stabilize their mood and reduce symptoms of depression or bipolar disorder. Other interventions, such as electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS), can also be effective for patients who do not respond to conventional treatments or have severe or treatment-resistant depression.
– Safety planning and means restriction: Safety planning and means restriction are strategies that can help reduce the access and availability of lethal means for suicide, such as firearms, medications, or pesticides. Safety planning involves creating a personalized plan with the patient that outlines the steps they can take to cope with a suicidal crisis, such as contacting a trusted person, calling a helpline, or seeking professional help. Means restriction involves removing or securing potential means for suicide from the patient’s environment, such as locking away firearms or medications, or installing barriers on bridges or balconies. These strategies can help prevent impulsive or fatal suicide attempts by increasing the time and distance between the suicidal urge and the act.
– Follow-up and aftercare: Follow-up and aftercare are crucial for maintaining contact and continuity of care with high-risk patients after a suicide attempt or discharge from a hospital or clinic. Follow-up and aftercare can include phone calls, text messages, emails, letters, home visits, or peer support groups that provide ongoing support, monitoring, and encouragement to the patient. These interventions can help reduce the risk of repeat suicide attempts, enhance adherence to treatment plans, and increase social connectedness and coping skills.
Challenges and Opportunities for Suicide Prevention in High-Risk Patient Populations
Despite the availability of effective strategies and interventions for suicide prevention in high-risk patient populations, there are still many challenges and gaps that need to be addressed. Some of these challenges are:
– Stigma and discrimination: Stigma and discrimination are major barriers to seeking and receiving mental health care for many high-risk patients. Stigma refers to the negative attitudes and beliefs that society has towards people with mental disorders or suicidal behavior. Discrimination refers to the unfair treatment or exclusion that these people face in various domains of life, such as education, employment, health care, or social services. Stigma and discrimination can lead to shame, guilt, fear, isolation, or hopelessness among high-risk patients, which can deter them from accessing care or disclosing their suicidal thoughts or plans. Stigma and discrimination can also affect the quality of care that these patients receive from health professionals or institutions, which may lack adequate training, resources, or sensitivity to address their needs.
– Lack of awareness and education: Lack of awareness and education about suicide prevention among high-risk patients, their families, and the general public is another challenge that hinders the detection and intervention of suicidal behavior. Many people may not recognize the signs and symptoms of suicidal risk, or may not know how to respond or where to seek help. Some people may also have misconceptions or myths about suicide, such as that it is a personal choice, a sign of weakness, or a result of a single event. These beliefs can prevent people from reaching out for help or offering support to others who may be struggling. Lack of awareness and education can also contribute to stigma and discrimination, as well as to the underreporting and underestimation of suicide statistics.
– Fragmentation and coordination of care: Fragmentation and coordination of care are another challenge that affects the delivery and quality of suicide prevention services for high-risk patients. Fragmentation refers to the lack of integration and communication among different sectors and levels of care, such as primary care, mental health care, emergency care, or social services. Coordination refers to the lack of collaboration and cooperation among different stakeholders and actors involved in suicide prevention, such as health professionals, policy makers, researchers, advocates, or media. Fragmentation and coordination of care can lead to gaps, delays, or inconsistencies in the identification, referral, treatment, and follow-up of high-risk patients, which can increase their risk of dropping out of care or dying by suicide.
To overcome these challenges and improve suicide prevention efforts in high-risk patient populations, there are some opportunities and recommendations that can be considered. Some of these opportunities are:
– Promoting mental health literacy and awareness: Promoting mental health literacy and awareness among high-risk patients, their families, and the general public is an opportunity to increase the knowledge and understanding of suicide prevention, as well as to reduce stigma and discrimination. Mental health literacy and awareness can be enhanced through various strategies, such as campaigns, education programs, media guidelines, or online resources that provide accurate and evidence-based information about suicide prevention, as well as about the available resources and services for help. Mental health literacy and awareness can also foster a culture of openness and compassion that encourages people to seek help or offer support to others who may be at risk.
– Strengthening the capacity and quality of care: Strengthening the capacity and quality of care for high-risk patients is an opportunity to improve the access and availability of effective suicide prevention services across different settings and contexts. Capacity and quality of care can be improved through various strategies, such as training health professionals in suicide prevention skills, implementing standardized screening and assessment tools, adopting evidence-based treatment protocols and guidelines, providing adequate supervision and support for staff, ensuring sufficient funding and resources for programs and facilities, or evaluating the outcomes and impact of interventions.
– Building partnerships and networks: Building partnerships and networks among different sectors and stakeholders involved in suicide prevention is an opportunity to enhance the coordination and collaboration of suicide prevention efforts across different levels and domains. Partnerships and networks can be established through various mechanisms, such as coalitions, task forces, committees, or platforms that bring together representatives from different disciplines, sectors, or organizations that share a common goal or interest in suicide prevention. Partnerships and networks can facilitate the exchange of information, experiences, best practices, or resources among different actors, as well as the development and implementation of joint policies, plans, or actions that address the needs and challenges of high-risk patient populations.
Suicide prevention is a priority for global health that requires urgent action from all sectors and stakeholders. High-risk patient populations are among the most vulnerable groups that need special attention and support to prevent suicidal behavior. There are effective strategies and interventions that can help reduce the risk of suicide in these groups, but there are also many challenges and gaps that need to be addressed. By promoting mental health literacy and awareness, strengthening the capacity and quality of care, and building partnerships and networks among different actors involved in suicide prevention, we can improve the lives and well-being of high-risk patient populations.
– World Health Organization. Suicide worldwide in 2019. WHO; 2021. https://www.who.int/publications/i/item/suicide-worldwide-in-2019
– O’Connor RC et al. A systematic review of universal school-based interventions for preventing adolescent dissertation topics examples suicidal ideation & behaviour: A meta-analysis & narrative synthesis. Lancet Psychiatry 2021;8(10):899-911. https://doi.org/10.1016/S2215-0366(21)00174-5
– Zalsman G et al. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry 2016;3(7):646-659. https://doi.org/10.1016/S2215-0366(16)30030-X