Webcast 04 – Developing a Suicide Risk Registry in Collaborative Care

Summary

Suicide is a leading cause of death in the United States and a preventable public health problem. In 2019, suicide took the lives of 47,511 Americans and it is estimated that an additional 1.4 million adults aged 18 years or older made non-fatal suicide attempts. Primary care providers are uniquely positioned to identify suicide risk and intervene. Roughly 45 percent of people who die by suicide visit a primary care provider in the month before their death. This far exceeds the one in five that have contact with mental health services during the same timeframe before death by suicide. Taken together these statistics demonstrate that primary care providers have access to patients at risk for suicide during a crucial window for intervention. Suicide Safer Care, sometimes called Zero Suicide, outlines clinical elements for improving care for suicidal patients including identifying at risk patients through screening and assessment, counseling on access to lethal means and creating a collaborative safety plan, making a referral to mental health services, and staying in touch during transitions in care. Patients are typically identified for Collaborative Care through the use of the Patient Health Questionnaire-9 (PHQ-9), a depression screening tool that asks about recent suicidal ideation in Question 9. As a result of implementing this screening tool, many patients at risk for suicide are identified in primary care settings, necessitating further assessment, care, safety planning, resources, and treatment. This presentation will describe the development and use of a population health registry to manage suicide risk among approximately 3,700 primary care patients enrolled in Collaborative Care Management across seven states. The registry’s use in Collaborative Care settings allows for substantially higher access to needed services than would be received as part of a traditional mental health referral. It facilitates more flexible and comprehensive follow up than treatment as usual, despite outpatient mental health being viewed traditionally as a “higher level of care.” Criteria for inclusion on the registry include endorsement of suicidal thoughts or behaviors on the PHQ’s Question 9 or Columbia- Suicide Severity Rating Scale (C-SSRS). Variables include, among others, if a positive screening for suicide risk resulted in appropriate assessment, provision of evidence-based interventions for suicide including the Safety Planning Intervention and Lethal Means Counseling, and if a member of the care team has connected with the patient in the past seven days. Patients on the registry are prioritized for psychiatric consultation. Behavioral care managers can utilize the registry to manage their panel of at-risk patients and managers can report by patients assigned to their supervisees, practice, or larger geographic area to ensure the care provided is consistent with the organization’s suicide safe care practices and policies.