Screenings, response plans can prevent suicide
WASHINGTON (Army News Service, Sept. 23, 2014) -- About half of those who commit suicide receive some type of medical care during the prior 30 days, but often risk factors are not detected.
No standard screening tool is in place to detect suicide risk among primary-care patients, said Col. Brett Schneider, director of behavioral health at Walter Reed National Military Medical Center, in Bethesda, Maryland.
Schneider spoke at the Psychological Health and Resilience Summit Thursday, at the Defense Health Headquarters in Falls Church, Virginia. He was joined by Dr. Kent Corso, program manager, behavioral health patient-centered medical home, National Capital Region Medical Directorate.
"So having a formalized way of assessing everybody who comes into primary care is a recommendation of the Clinical Practice Guideline," Schneider said, "but again, there is not one tool that had enough evidence to recommend it as the tool we should be using in the DOD."
Once somebody is screened positive, he said a risk assessment needs to be done.
"In the military, the biggest thing that is often a precipitant to suicide are break-ups in relationships or 'connectiveness,'" he said, adding, "things that increase impulsivity: drinking, insomnia, those kinds of things are acute risks for people who might start thinking about suicide or might actually try to commit suicide."
Schneider suggested trying to get a potential suicide victim to agree to a "safety contract" or "no-harm contract" or a "plan for safety." Corso recommended a "crisis response plan" created by the patient and caregiver together.
"Will you sit down with me and go through this piece of paper where we could look at the different things that contribute to your impulsivity and not being safe and feeling suicidal and can we work on a plan together of things you could do instead of feeling that way and can we put a list of people you could contact if these don't work -- do that," said Schneider.