When a person is facing a serious mental health crisis, they often go to or are taken to the hospital. While at the hospital, the focus is on stabilization and keeping them safe. But what happens once they leave?
Multiple studies show that a patient’s risk of suicide significantly increases once they are discharged from the hospital. [1] In the first week after discharge, the risk of suicide increases by 300 times higher compared to the general population. [2] Also, as many as 30% of patients admitted to the hospital for a suicide-related concern are re-admitted within a year. [3]
Something clearly needs to change. We must better support patients who experience a serious mental health crisis. We also need to help prevent a crisis from happening again. During this vulnerable time, patients deserve the best care possible so they can get on a path to healing. While there are many factors at play when it comes to post-discharge suicide risk, there are some steps that hospitals and clinicians can begin implementing to help start actionable change.
Before a patient is discharged from the hospital, there are steps put in place to help reduce the patient’s risk of suicide. These steps often include creating a safety plan and counseling on reducing access to lethal means. While these are meant to help reduce risk, they are often not enough. The patient is then discharged from the hospital with either a plan for follow-up outpatient care or a care referral. This transition is where the risk period begins.
There are many factors at play when it comes to suicide after hospitalization. Here are some of the key areas where the systems in place may be failing.
Inconsistent use of screening and assessment tools
Hospitals often vary in how they identify high-risk patients. Many of the tools focus on risk factors rather than digging deeper and identifying the root of the patient’s suicidal thoughts. These standard risk assessments can feel like a checklist rather than a unique, patient-centered approach to treating what lies beneath. They may miss specifics that could be helpful in treating the patient moving forward.
Fragmented care transitions
Currently, there is no standard protocol to follow when it comes to handing off patients in emergency departments to outpatient providers. This handoff is where a lot of the risk comes in because the next steps often rely heavily on the patient. Patients may leave the hospital feeling confused, unsupported, or ill-equipped to take the next steps toward getting long-term, sustainable care. It’s important to also remember that the patient just went through an extremely traumatic event and may still be feeling overwhelmed. It’s important that they have the correct steps laid out in front of them and a plan in place for care with a clinician who can provide further support.
Barriers to accessing outpatient mental health services
Ideally, the first follow-up session after discharge should happen as soon as possible. Unfortunately, follow-up care is not always straightforward or easy to access. Often, the patient does not follow their discharge plans. In fact, around only 50% of patients follow up on their referrals for outpatient care. [4] Depending on the patient’s situation, they may face several barriers when it comes to accessing outpatient care, whether it’s financial, logistical, or a combination.
In addition to each of the factors above, hospitals themselves are also facing their own challenges. Many hospitals are overwhelmed. From overcrowded emergency departments to short (and often overworked) staff, hospitals struggle to keep up with the demand. Clinicians may not have the capacity to do a thorough suicide risk assessment of the patient as well as intervention work. There may simply even not be enough space for patients at risk to stay in the hospital for as long as they need to.
Hospitals and emergency departments can also be extremely stressful environments for those already dealing with a mental health crisis. People in emergency rooms for mental health reasons may often be deprioritized due to other more urgent needs coming through the doors. This means that those in a mental health crisis may be waiting for hours if not days before they are truly seen and helped in the ways they may need.