One of the biggest obstacles health systems face in preventing suicide is losing touch with people when they’re vulnerable. In most U.S. hospitals, a person who arrives at an emergency room after a suicide attempt is generally hospitalized, stabilized and, once deemed to be at lower risk, discharged with guidance to follow up with a mental-health professional. But many don’t take that advice. Even under less acute circumstances–when they’re receiving routine care–people fall through the cracks.
The new best practices emphasize putting people on the grid and not letting go. Few places do it as well as Centerstone, a large community mental-health center based in Tennessee that obsessively follows up with patients. By reprogramming its digital health-records system, Centerstone made screening for suicide risk mandatory; patients who respond a certain way are automatically designated at risk and seen more frequently. If one of these patients doesn’t show up for an appointment and can’t be reached within a few minutes, a 24/7 crisis team is pinged. “They’re gonna come after you–in a loving, kind, gentle way, but they’re going to pull out all the stops to make contact with you so that we know that you’re not in any kind of major crisis,” says Becky Stoll, vice president for crisis and disaster management for Centerstone. One of these routine phone calls reached a patient as he was standing on the edge of a bridge ready to jump; the caller persuaded him to return to the clinic. Within two years of making this change and others in 2014, the rate of suicide deaths at Centerstone had dropped by 64%.