Focused on 6-month high-risk period after emergency department visit.
Enhanced brief intervention services administered to patients presenting with suicidal concerns to emergency departments (ED) helped reduce subsequent suicidal behaviors, a study found.
The large-scale cohort comparison study compared outcomes for 1,186 patients who received SPI+ in five Veterans Affairs (VA) ED intervention sites with 454 matched controls from four VA sites delivering treatment as usual. Patients in the intervention and control groups were mostly male and in middle-age.
The SPI+ intervention initiative and follow-up criteria included the following six steps:
- Identify personalized warning signs for an impending suicide crisis
- Determine internal coping strategies that distract from suicidal thoughts and urges
- Identify family and friends who are able to distract from suicidal thoughts and urges and social places that provide the opportunity for interaction
- Identify individuals who can help provide support during a suicidal crisis
- List mental health professionals and urgent care services to contact during a suicidal crisis
- Lethal means counselling for making the environment safer
Stanley touched upon the lethal means criteria, describing the need for such conversations as those concerning gun control as "a natural discussion when talking with suicidal patients because about 50% of all suicides in the U.S. are with firearms." She highlighted that discussions of firearm possession are not necessarily primary, but rather fit into the larger rubric of discussions that must take place, adding, "We talk about temporary removal of weapons, safe storage, etc., in much the same way we discuss access to lethal medications."
Further to the safety plan, provided prior to ER discharge, SPI+ included sustained follow-up via telephone consultation, by appropriately trained and supervised project staff (social workers or psychologists). Contact was attempted within 72 hours of discharge and included mood check and risk assessment, review of the SPI, and facilitation of treatment engagement.
Follow-up continued weekly and was generally discontinued after two calls if the patient had at least one behavioral outpatient health appointment in place or if the patient requested no further contact.