How to Handle the Threat of Suicide and Self Harm in Your Practice

How to Handle the Threat of Suicide and Self Harm in Your Practice

posted by Kathy Everitt on Friday, November 30, 2018

It is important to recognize the signs of suicide or self-harm in patients. Toward this goal, it can be beneficial to establish a policy that reinforces your commitment to all patients’ safety and the agreed-upon actions to take. 

Any patient who verbalizes thoughts of harm to himself/herself or others or shows signs of self-harm should be assessed and protected from harm as much as possible. 

Some areas to consider for your policy:

  • The use of a screening tool (when and how it is used)
    • The screening tool should be consistent with your patient population and used for all patients. For example a first step might be a tool such as the PHQ-2 (patient health questionnaire) that asks: Over the last two weeks how often have you:
      • Shown little interest or pleasure in doing things? (rating 0 for not at all to 3 for nearly every day)
      • Felt down, depressed or hopeless? (rating 0 for not at all to 3 for nearly every day)
    • Re-enforce the importance that:
      • Staff should listen for verbal clues such as expressions of hopelessness, not wanting to live or being unable to cope. 
      • These clues are especially important if the patient has a history of previous suicide attempts. 
      • Whenever a patient expresses an intent to harm, it should be taken seriously. 
    • Note any signs of self-harm (such as cutting, scars, bruising) and ask the patient about these signs
    • Know the risk factors associated with suicide/self-harm as determined by the CDC (Center for Disease Control) and assess each patient for:
      • History of previous suicide attempts
      • Family history of suicide
      • Serious illness or physical impairment
      • History of depression or other mental illness
      • History of alcohol or drug abuse
      • Stressful life event or loss (e.g., job, financial, relationship)
      • Loss of appetite, sleeping difficulty
      • Social isolation
      • History of interpersonal violence
    • If you determine the patient to be at risk, your actions should reflect the crisis level:
      • Know your community resources: where and how to get help
      • Identify and offer coping strategies and provide resources for reducing the risk
      • Have a referral network of mental health professionals already established and refer them for care within one week of assessment
      • Ask the patient’s permission to contact support/family members so that you can share your concern
        • HIPAA permits a clinician to contact family members/caregivers without the patient’s permission when the clinician believes the patient may be in danger to self or others
      • Determine whether law enforcement should be contacted
      • Keep the patient in the safe environment and ensure the patient is not left alone
      • If the patient is determined to leave, refer them to a local ER
      • If the patient does leave, request a safety check by law enforcement
    • Document your actions in the patient’s record:
      • Include your decision-making process
      • All communications with patient and family members/caregivers
      • Why patient is at risk
      • Identify and detail any safety plans agreed upon to reduce the risk
      • Follow-up plans to support the patient

For more information:

  1. documentation
  2. referrals
  3. risk management
  4. unhappy patient

About The Author

Kathy Everitt

Kathy brings with her more than 30 years of professional liability experience to NCMIC, encompassing underwriting, sales management, as well as risk management consultation services for healthcare professionals. She has earned her CPHRM designation and, as a licensed property/casualty agent, Kath ... read more

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