Suicide is the leading cause of preventable death in Utah, accounting for
approximately 10 deaths a week. According to 2012-2014 data from the Centers
for Disease Control and Prevention, each year, an average of 557 Utahns
died by suicide and more than 4,700 Utahns attempted suicide. The data
show that Utah adults have the highest incidence of suicidal thoughts in the
U.S.—6.8 percent of Utah adults reported having suicidal thoughts during
2008-2009. The national average during the same period was 3.7 percent.
The U.S. Preventative Services Task Force discovered that many patients who die
by suicide visit a healthcare provider within a month before their deaths (2014),
which means all clinicians are in an excellent position to help. With the right tools
and resources in place, we believe we can help prevent suicide among our patients
and in our communities.
The Behavioral Health Clinical Program instituted a Suicide
Prevention Care Process Model
Prevention starts with asking questions, and Intermountain’s Suicide
Prevention Care Process Model (CPM) offers questions that are
informed by guidelines from the American Association of Suicidology
and the Center for Suicide Risk Assessment at Columbia University
Medical Center.
The CPM provides guidance for prevention, assessment, and treatment
for patients with suicidal thoughts, feelings, or behaviors. The CPM
focuses on prevention and treatment in primary care, emergency
rooms, and hospitals, though may also be applied to other clinical
environments. It encourages clinicians to screen patients through a
series of questions and observations to determine where they may
fall on the Columbia-Suicide Severity Rating Scale (C-SSRS) in
conjunction with a risk assessment and safety planning. The scale
is used to assess how likely an adult or adolescent is to commit
suicide and is used in both inpatient and outpatient environments.
Intermountain uses several versions of the C-SSRS to consistently
identify and track patient suicide ideation and behaviors across the
continuum of care.
Using the C-SSRS scale, Intermountain developed a number of
algorithms (question and answer prompts) that guide clinicians and help
them make decisions and offer appropriate education. These algorithms
are integrated into iCentra, Intermountain’s electronic medical record
system, to give clinicians decision support and education links based on
patient responses. Safety planning is a critical and proven component of
helping these patients. Intermountain provides safety tools patients can
use when suicidal thoughts arise after discharge.
Six Goals of the Suicide Prevention Care Process Model
- Reduce the
suicide rate in
our communities
and in our
healthcare
system.
- Establish reliable
incidence and
prevalence
rates within
Intermountain.
- Integrate proven
tools for identifying
and screening
patients in emergency
departments, primary
care and behavioral
health clinics, and
other settings.
- Coordinate our
resources
(between primary
care and mental
health clinics,
community
resources, emergency
departments,
and so on)
to reduce patient
suffering and improve
access to resources.
- Modify risk factors
(e.g., mental and
physical health
problems)
when possible and
refer to specialized
treatment when
necessary.
- Drive appropriate
use of Patient
Safety Attendants
in emergency
departments.