Resources You Can Use: PRMS Committed to Helping Prevent Suicide

Suicide is the 10th leading cause of death for Americans and a very real professional liability risk for psychiatrists working with patients. September is National Suicide Prevention Month, which makes the tragic and important topic of suicide all the more timely. PRMS is committed to helping clinicians deal with this very sad and real patient safety risk by offering risk management resources and advice.

“Suicide continues to be a leading cause of lawsuits against psychiatrists,” explained Jean Clark Bates, RN, BSN, MPPM, PRMS 
Senior Vice President of Claims. “The key is for providers to integrate suicide prevention strategies into their practice and to use tools to better assess suicide risk among their patients.”

How real is the risk? According to the American Foundation for Suicide Prevention’s (AFSP) latest data from the Centers for Disease Control and Prevention, in 2013 (the most recent year for which full data are available), 41,149 suicides were reported in the U.S. That means someone died by suicide every 12.8 minutes.

From 1986 to 2000, suicide rates in the U.S. dropped from 12.5 to 10.4 suicide deaths per 100,000 people, but over the next 12 years, the rate has generally increased and reached 12.6 deaths per 100,000 in 2013.

Who is most at risk? In 2013, the highest suicide rate (19.1) was among people 45 to 64 years old, while the second highest (18.6) occurred in those 85 years and older. Of those who died by suicide in 2013, 77.9% were male and 22.1% were female. White males accounted for 70% of all suicides in 2013.

Firearms where the most common method of suicide, accounting for just over half (51.4%) of all deaths, followed by suffocation (including hangings) at 24.5% and poisoning at 16.1%.

Recent suicides of people like actor Robin Williams illustrate the myriad suicide risk factors. In addition to mental health conditions, substance abuse disorders and serious or chronic health conditions and/or pain, they include environmental factors, such as exposure to another person’s suicide or to graphic or sensationalized accounts of suicide, according to the AFSP.

Other risk factors include access to firearms and drugs and prolonged stress, which may include harassment, bullying, relationship problems and unemployment, not to mention death, divorce, or job loss. Historical factors also can play a role, including a family history of suicide or suicide attempts, mental health conditions and childhood abuse, according to the AFSP.

Bates said psychiatrists may have a difficult time assessing suicide risk for a number of reasons. In some cases, medical training to assess the risk is lacking. Another obstacle is inadequate assessment.

“In all cases, a comprehensive assessment and very good documentation of the assessment and treatment plan going forward to manage that risk is key,” Bates said. PRMS’ risk management team developed the 3 C’s – proven strategies to improve patient care – collecting information, communicating, and carefully documenting.

Many years ago, PRMS contributed to the printing and distribution of a Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) pocket card to the nation’s psychiatric residency programs.  The Substance Abuse and Mental Health Services Administration has used the card to develop “Suicide Safe,” a free mobile app optimized for tablets to help assess the risk of suicide.  It’s available here.

Providers can explore interactive case studies, scenarios and get tips for talking with patients who may need intervention. They can also use the app to quickly access and share information, including crisis lines, fact sheets, educational opportunities and treatment resources, which can be filtered by type and distance.

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