Suicide was the 12th leading cause of death in the United States in 2020.
According to the Centers for Disease Control and Prevention, the suicide rate in the US increased by 33% from 1999 to 2019. CDC reports even higher increases among certain racial and ethnic groups: Native American and Alaskan Native (139%) and men (71%), Black women (65%), White women (68%) and men (40%), and Hispanic women (37%). Other people at higher risk of suicide include veterans, people who identify as LGBTQ, adolescents and young adults, and disaster survivors.
Polling data shows that most Americans believe suicide is preventable, and the latest scientific research supports this view. Suicide prevention requires a range of interventions, but one simple step is hospital screening — that is, asking patients entering hospitals or health systems a few questions to determine if they are at risk of harming themselves. Such screening allows healthcare professionals to assess patients’ needs and then refer or refer them to evidence-based care.
According to a recent study, about half of the people who died by suicide over the 10-year period studied had seen a doctor at least once a month before their death. Further research suggests that if they had been screened for suicidal risk by these providers, many might have received treatment and survived. In fact, a 2017 study in eight emergency departments in seven states found 30% fewer suicide attempts in patients who were screened and received evidence-based care compared to patients who were not screened. Another study looking at veterans’ hospitals found that patients who were evaluated and then treated clinically were half as likely to engage in suicidal behavior and more than twice as likely to seek psychiatric treatment as patients who were received usual care.
Most US health systems only screen patients for suicidal risk if they have already been diagnosed with a behavioral problem or mental health disorder. However, some industry leaders have already taken steps to screen a broader patient population for suicidal risk. For example:
- In 2001, Michigan’s Henry Ford Health System was the first to expand its suicide prevention and screening efforts with the goal of ending suicide within the system. The overall result was an 80% reduction, including an 18-month period between 2009 and 2010 with zero suicides. Notably, this statistically significant decrease occurred while Michigan’s overall suicide rate was increasing.
- Parkland Hospital in Dallas, one of the largest public hospitals in the country, successfully introduced universal suicide risk screening in 2015.
- The University of Pennsylvania Health System screens all patients in its emergency department and outpatient facilities.
- The Billings Clinic, a rural health system for Montana, Wyoming and the western Dakotas, examines all patients in their emergency room.
Physicians and healthcare managers recognize the importance of reducing suicides, but may fear that screening will add another costly and time-consuming burden to already-overwhelmed surgeries. Fortunately, many if not all of these concerns can be addressed.
First, screening and follow-up care are reimbursable by insurance. Second, screening surveys can be as short as two questions. After implementing universal screening, Parkland Hospital found that 96% of patients screened negative, warranting no further action by providers. Finally, in the few cases that require special attention, the provider may refer patients to appropriate care and services—including safety planning, follow-up contact, and counseling—that are typically available at that hospital or health care system or through other mental health and suicide prevention resources in the community. Anecdotal evidence from Parkland also suggests that screening did not disrupt hospital workflows and has connected thousands of people to much-needed mental health services.
Because screening all patients for suicide risk is still limited to a small minority of healthcare settings, most providers and administrators need help understanding how to integrate it into their day-to-day operations. Key questions include: who should conduct the assessments, who should be evaluated, how to ensure systems provide equitable care and address the needs of underserved populations, how to obtain insurance reimbursement, and how to measure outcomes and adjust programs as needed. Providers also need screening tools integrated into their electronic health record systems to standardize and streamline their risk identification processes. Hospital accreditation and regulatory bodies can play a role in promoting widespread adoption and consistent implementation.
As the COVID-19 pandemic increases anxiety, depression, financial stress, substance abuse, and other risk factors for suicide, hospitals and healthcare systems have a low-risk, high-reward opportunity to identify and treat people who would be likely to harm themselves. The cost of screening is minimal and the benefits can be measured in thousands of lives.
If you or someone you know needs assistance, please call the National Suicide Prevention Lifeline at 800-273-8255 or text TALK to 741741 to reach a crisis counselor.
Kristen Mizzi Angelone leads Pew’s Suicide Risk Reduction Project.