How Are Hospitals Helping Patients at Risk of Suicide?

Nearly 46,000 people died by suicide in the United States in 2020. And almost half of those who die by suicide interact with the health care system within four weeks of their death, giving health care providers an opportunity to screen for suicide risk and connect at-risk patients with potentially life-saving care.

Courtesy of David Baker

Further, suicide rates have been rising nationwide for years, which in 2019 prompted The Joint Commission, an independent hospital accrediting organization focused on ensuring health care quality and patient safety, to update its national patient safety goals on suicide prevention. These goals require the nearly 3,800 Joint Commission-accredited hospitals—approximately 80% of all facilities in the nation—to screen all patients being treated for behavioral health conditions for suicide risk and to have discharge policies that include counseling and follow-up care for anyone identified as at-risk.

Now, The Joint Commission and The Pew Charitable Trusts have partnered on a national survey of accredited hospitals to better understand what suicide prevention practices they are using and to assess whether the Joint Commission should increase hospital requirements in order to further reduce suicides. The survey results are slated for release in early 2023.

Pew spoke with Dr. David Baker, executive vice president for health care quality evaluation at The Joint Commission, about the state of suicide prevention in hospitals today, the goals of the survey, and how the data can inform the Joint Commission’s work for suicide prevention in the U.S. This interview has been edited for length and clarity.

Q: As we await the survey results, what do we already know about suicide prevention practices in hospitals and emergency departments?

A: We know that over the last 18 months, 89% of Joint Commission-accredited hospitals were compliant with our suicide screening requirements. This means that they screened all patients who were evaluated or treated for behavioral health conditions for suicide risk using validated screening and assessment tools. And we know that 97% of hospitals were compliant with our discharge planning requirements, which requires that hospitals develop and adhere to written policies and procedures for counseling and follow-up care with patients before they leave the hospital. This discharge planning can involve identifying coping strategies and sources of support that patients can use during a suicidal crisis and providing crisis call center contact information.

Q: Are you satisfied with those numbers? 

A: While it’s encouraging to see high compliance with our requirements, those requirements aren’t prescriptive in nature. For example, we don’t specify what hospitals’ written policies and procedures for counseling and follow-up care should include. And some hospitals implement additional prevention efforts—both in screening and assessment of suicide risk and in discharge planning.

Q: Can you tell us more about those additional efforts?

A: Actually, not as much as I’d like. We need to know more about what those efforts are, how prevalent they are across accredited hospitals, and the effect they have on improving patient care.

We do know that some hospitals are going beyond our current screening standards and implementing universal suicide risk screening—that is, where every single patient, no matter why they’re in the hospital, is screened for suicide risk. We’d like to know how many hospitals are implementing a universal screening protocol or other screening practices that go beyond our current requirement. 

And some hospitals are collaborating with outpatient providers to expedite counseling appointments when a suicidal patient is preparing to leave the hospital and following up with patients until they attend that appointment. Though they aren’t currently required for accreditation, such practices are important because studies show that suicide risk remains high among patients who leave psychiatric facilities and emergency departments.

Our survey will help us understand how many, and to what extent, hospitals are implementing these and other leading practices in suicide prevention, and whether requiring all accredited hospitals to implement similar practices would improve patient care and reduce suicides.

Q: Is there anything else you hope to learn from the survey?

A: Absolutely. For hospitals that have elected to adopt screening practices that go beyond our requirement, we hope to understand what barriers and hardships come with screening more patients. We also need to know what challenges hospitals have faced in implementing discharge planning protocols, and more importantly, how have they overcome those obstacles and successfully deployed these initiatives. We’d also like to know what prevention practices seem to pose the most significant challenges to the field so we can determine how best to address those challenges.

Q: What can your organization do with this information? 

A: The survey data can help us determine whether there’s more The Joint Commission can do to meet our national patient safety goals around suicide prevention and which additional suicide prevention interventions, if any, should be required. It can also shed light on opportunities to further improve safety, health care quality, and suicide prevention efforts across our hospital network.

And as part of our organization’s mission, we provide a multitude of resources designed to help and support our accredited organizations to meet our patient safety goals. Ultimately, the survey data can help inform those efforts.

Q: Any final thoughts?

The Joint Commission is committed to ensuring hospitals provide the very best suicide care to their patients. So, we hope we can do more around suicide prevention and eventually include in our accreditation requirements some of the leading practices that hospitals have already implemented to improve suicide care for their patients.