Department of Veterans Affairs
Department of Defense
Key Points found in Scroll Box below: 1. Follow-up and Monitoring:
a. Establish timely and ongoing follow-up care for those who attempt suicide and others at high acute risk in the immediate period after discharge from acute care settings and identify the responsible provider during this period.
b. Patient should be re-evaluated following an inpatient or Emergency Department discharge, as soon as possible, but not later than 7 days.
c. High acute risk patient should be actively managed to assure adherence and coordinated care.
d. Patients at high acute risk should be followed closely (e.g., weekly for the first month) after they are identified or after inpatient or ED discharge.
e. Consider contacting the patient before initial follow-up appointment to monitor transition to the outpatient care plan and to reinforce adherence to the discharge plan.
f. The frequency of outpatient follow-up should be determined on a case-by-case basis. It should be greatest after attempts and related behaviors, after change in treatment, or after transitions to a less restrictive setting of care. Once the patient stabilizes and is engaged in care the frequency of follow-up can be decreased based on: 1.The current level of risk; 2.The requirement of the treatment modality; and 3.The patient’s preference.
2. Reassessment and Monitoring
1. Follow-up appointments should include:
a. Reassessment of: interim events, changes in suicide risk; symptoms of mental disorder; and medical conditions
b. Provision of specific treatment targeting suicidality
c. Continuation of treatment of co-occurring underlying conditions
d. Monitoring the symptoms of co-occurring conditions. Assessment of adherence and adverse effects
f. Modification of treatment, as indicated
g. Support, reinforcement, and update of the safety plan
h. Addressing patient/family concerns
i. Determination of the frequency of future follow-up
3. Adherence to Treatment and Follow-up care Strategies
-Case- or Care - Management Strategy
-Facilitating Access to Care After Discharge
-Communication of Caring Messages (Mailing letters/postcards)
-Outreach in the Patient’s Home
-Counseling and Psychosocial Interventions Other than Manual-driven Psychotherapies
4. Continuity of Care - Coordination and Collaboration of Care.
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Questions? Email: [email protected]
- The Assessment and Management of Risk for Suicide Working Group. VA/DOD Clinical Practice Guideline for Assessment and Management of Patients at Risk for Suicide. Department of Veterans Affairs, Department of Defense. June 2013. Pg. 58-61.
Peer-Reviewed Journal Article References:
Kayman, D. J., Goldstein, M. F., Dixon, L., & Goodman, M. (2015). Perspectives of suicidal veterans on safety planning: Findings from a pilot study.Crisis: The Journal of Crisis Intervention and Suicide Prevention, 36(5), 371–383.
Spangler, D. A., Muñoz, R. F., Chu, J., & Leykin, Y. (2020). Perceived utility of the Internet-based safety plan in a sample of internet users screening positive for suicidality.Crisis: The Journal of Crisis Intervention and Suicide Prevention, 41(2), 146–149.
Zonana, J., Simberlund, J., & Christos, P. (2018). The impact of safety plans in an outpatient clinic.Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(4), 304–309.
QUESTION 13 When is the sustainability of treatment and safety plans enhanced?
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