SECTION: Behavioral Health Integration / REVIEW / REVISED / DATE / APPROVAL
Suicidal Intervention / 8/2/16 / 7/25/16 / 3/2/15 / 4/6/15
8/1/2016
9/12/16
Policy:
Any patient or employee identified by phone or in person as having suicidal ideation shall receive intervention and referral to appropriate care. If a patient endorses #9 at all on the PHQ-9, an immediate suicide assessment should be conducted.
Purpose:
To establish the proper procedure for intervening with patients who have suicidal ideation.
Procedure:
At the clinic:
1. Assess protective factors and risk factors.
2. Based on risk assessment, protective factors and risk factors, consult with the parties involved (i.e. behavioral health consultant (BHC), behavioral health provider, primary care provider, RN, dental staff, etc.) If the BHC is a student, BHC student should contact his/her immediate academic supervisor
3. If the patient/client is a high risk and requires hospitalization:
o Ask patient/client if s/he will voluntarily be admitted for inpatient evaluation at Altru Hospital (The Stadter Center may be an option). Voluntary is best.
§ Arrange for transportation
· Best if a trusted friend or relative will take them to the Altru Emergency Department (ED).
· Record this person’s name and phone number.
· Contact Altru ED or referral agency and let them know VCHC is sending a patient/client to the facility for suicidal ideation. Upon arrival at the hospital, have the referral facility call you to confirm that the patient/client arrived. If referral facility does not call to confirm arrival of individual within timely manner, it is the responsibility of VCHC staff to contact the referral facility and document outcome accordingly.
· A provider should NEVER transport a patient/client him/herself.
· If an individual has no means of transportation and no means of affording transportation, 9-1-1 can be called.
o When calling 9-1-1, state there is “a non-emergent patient with suicidal ideation needing transportation to Altru Hospital/Stadter Center/etc.”
o 9-1-1 will send appropriate personnel. Law enforcement may conduct their own risk assessment with the patient/client and then determine transportation for individual.
o If the patient/client is involuntary, it is best to contact law enforcement to ensure safe transportation to the hospital. When contacting law enforcement, state if patient/client has intent to harm him/herself or others, has weapons, and/or has fear (or history of fear) of law enforcement.
4. Do not let the patient/client leave the premises until the risk assessment is completed and a plan is in place. If the individual is requiring hospitalization, he/she should not leave the building until transportation to referral facility.
5. Depending on the client/patient’s severity, he/she may need to remain in sight or with someone at all times until they are transported to the referral facility.
6. Patient/client should fill out a Release of Information for the referral facility as transportation is being arranged.
7. If the patient/client has a history of seeing a behavioral health provider at another facility, VCHC staff should contact that provider and notify the provider that his/her client is being hospitalized.
8. All information including assessment, plan of action, individuals involved, resolution, and other related information must be documented in the patient/client chart.
By Phone:
1. If a staff person receives a phone call from someone who indicates they are suicidal, the staff person should:
· Try to obtain the name, phone number, and location/address of the caller.
· Ask the caller if they have a plan to commit suicide, how they plan to do it, and if they have the means available. If the caller has these things, they are at high risk.
· Try to find support. If the staff person answering the call is a non-clinical staff, they should try to reach someone from behavioral health, nursing, or a provider for assistance.
· Try to obtain permission to call 911 for the caller, but a call may be placed even without permission if an address has been obtained.
2. If the staff person requires support and none is available, as a last resort the staff person may:
· Ask to place the caller on hold and dial 6911 to reach either a behavioral health consultant, charge nurse, or the clinical director. The call will be forwarded to one of them through this line. If they are not available, the staff person will remain by the phone to reclaim the call. The 6911 extension may be used for any mental health-related crisis.
· If the caller indicates they have taken some type of poison or have overdosed, the staff person will facilitate a call to Poison Control at 1.800.222.1222 for the caller.
· The staff person may call 911 or have a back up person contact 911 as soon as possible. The staff person should be prepared to provide the following information if they have obtained it:
i. Caller name/address/phone number
ii. Patients self-reported plan to commit suicide
· Staff should place the caller on hold or transfer the call only with the caller’s permission and as a last resort.
· If the call gets dropped and the Staff person has obtained the caller’s address, Staff may call law enforcement and ask them to complete a welfare check on the caller.
· Staff should remain with the caller until assistance arrives or the call is lost and cannot be re-established.
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