Lead/Presenter: Peter Mills, VA National Center for Patient Safety
All Authors: Mills PD (VA National Center for Patient Safety), Soncrant C (VA National Center for Patient Safety) Palmer, MC (VA National Center for Patient Safety) Webb, B (VA National Center for Patient Safety)
Objectives:
Suicide is a leading cause of death in the US with 47,500 deaths by suicide reported in 2019. In 2020, 12.2 million adults reported suicidal ideation and 1.2 million adults attempted suicide. The rate of suicide in the week after discharge in the general population is estimated to be 2950 suicides per 100 000 person years and the rate for suicide attempts is higher. The purpose of this study was to examine suicide attempts in the week after discharge from a mental-health unit across the VHA.
Methods:
VHA suicide attempts within seven days of discharge from a VHA mental-health admission between 01/01/2021-12/31/2021 were analyzed. A retrospective analysis of the VHA Issue Brief (IB) database, a centralized event reporting system, was conducted. Interrater reliability was achieved, and the reports were coded for the method of suicide attempt, cause, number of days after discharge, location of event, and reported mental-health conditions.
Results:
We identified 1405 IB reports of suicide deaths and attempts in VHA in 2021. After excluding deaths, events on campus, or events outside of the reporting window (7 days from discharge), 108 cases remained for analysis. There were 60,414 mental health discharges during this time, resulting in a rate of 178.79 suicide attempts per 100,000 discharges. Overdose was the most common method (59.26%) followed by cutting or stabbing (12.04%) and hanging (6.48%). Causes for the attempts included mental health issues, irregular discharge, eviction, relapse on alcohol or drugs, pain, legal, financial, and family problems. Over 20% of the attempts occurred on the same day as discharge, with another 21.6% on day one. The most common mental health diagnosis or condition is substance abuse disorder followed by PTSD, depression, suicidal-ideation, psychotic disorders, prior suicide attempts and anxiety.
Implications:
Taken together, the evidence for contributing factors indicates that evidence-based psychotherapy, in addition to enhanced discharge planning, support, and follow-up after discharge, could reduce attempts. In addition, enhanced psycho-social supports for housing, legal and financial help may also reduce the likelihood of these attempts. Another important result from this study is that over 42% of the suicide attempts after discharge occurred within one day of discharge. A standardized suicide risk assessment at discharge to help ensure patient are ready to leave the hospital may also help reduce these events.
Impacts:
Our results suggest the need for enhanced treatment and follow up for patients recently discharged from a mental health admission to include: 1. Evidenced-based, suicide-focused, treatment for patients while in the hospital. 2. Enhanced psychosocial evaluation while in the hospital to assess for needed help in the areas of housing, legal and financial concerns, family conflict and recent losses. 3. Follow up treatment using the WHO-BIC model for patients at discharge. 4. Enhanced suicide risk assessment for all patients at discharge, with increased focus on access to both firearms and medication or other drugs for overdose. 5. Consider caring communications in the weeks after discharge and home-visits to ensure connection with outpatient treatment and supports.