A Practical Approach to Suicide Prevention After Emergency Department Visit

suicide prevention
Recognizing the warning signs and asking the right questions can help someone at risk.
Implementing the Safety Planning Intervention in EDs along with a follow-up telephone call may be an effective brief suicide prevention intervention.

The Safety Planning Intervention combined with telephone follow-up may be effective in reducing repeated or ongoing suicidal crises, according to a study published in JAMA Psychiatry.

Though rates of suicide have increased significantly over the past 20 years, it can still be difficult to treat patients effectively after a suicide-related emergency department visit. Close to 50% of patients refuse or do not comply with treatment postdischarge, and past interventions such as no-suicide contracts have proven ineffective. Researchers conducted a study to test a modified version of the Safety Planning Intervention as a potential new strategy.

Between 2010 and 2015, patients at 5 intervention sites (n=1186) and 4 control sites (n=454) who were admitted to emergency care with a suicide-related concern were evaluated for 6 months after discharge. Eligible patients were ≥18 years and did not require inpatient hospitalization after emergency treatment. They majority of patients in the intervention group were men (88.5%), and the mean age was 47.15 years.

The Safety Planning Intervention identifies personal warning signs for suicidal crisis, coping strategies, family and friends who may distract from suicidal thoughts or be able to provide support during a crisis, professionals and services who may be contacted during a crisis, and ways to make one’s environment safer. This study added a telephone follow-up component that was typically administered by staff psychologists or social workers within 72 hours after discharge. The follow-up included risk assessment, review of the Safety Planning Intervention, and assistance with further treatment.

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Patients in the intervention group had 45% fewer suicidal behaviors in the 6 months after discharge.  In addition, the intervention group was less likely to engage in suicidal behaviors than patients in the control group. The odds of the intervention group attending ≥1 outpatient mental health visits had doubled (odds ratio 2.06; 95% CI, 1.57-2.71; P <.001) compared with the control group.  Although a single mental health visit may seem insufficient, researchers pointed out that the first visit is often the primary hurdle for patients seeking treatment for suicidal thoughts and behaviors.

One limitation of the study was its reliance on medical records for suicidal behaviors, which patients may not necessarily report. The participant population may have also been at a lower risk for suicide, given that they were not admitted for inpatient hospitalization. Nonetheless, the Safety Planning Intervention may be a practical, effective tool for patients and staff in managing the increasing public health risk for suicide.


Stanley B, Brown G, Brenner L, et al. Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients [published online July 11, 2018]. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2018.1776