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

  1. Reduce the suicide rate in our communities and in our healthcare system.
  2. Establish reliable incidence and prevalence rates within Intermountain.
  3. Integrate proven tools for identifying and screening patients in emergency departments, primary care and behavioral health clinics, and other settings.
  4. 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.
  5. Modify risk factors (e.g., mental and physical health problems) when possible and refer to specialized treatment when necessary.
  6. Drive appropriate use of Patient Safety Attendants in emergency departments.