The Joint Commission is considering whether its hospital accreditation standards should include more requirements tied to suicide prevention efforts.
The accrediting body already has standards intended to prevent suicide among patients treated for behavioral health conditions once they are discharged. However, there are no standards for other patients related to detailed safety planning, including how individuals are transitioned to outpatient care providers and how access to lethal weapons is restricted.
The internal discussions follow a recent commission survey of hospitals that found only 4% of respondents reported implementing key suicide prevention practices recommended by behavioral health experts for all hospital patients. The outcome of the discussions could mean imposing more requirements or providing "more education and resources to help organizations do this without making it a requirement," said Scott Williams, research director at The Joint Commission.
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Creating additional accreditation requirements could increase the staffing burden on providers and put additional pressure on financial resources stretched thin as a result of reimbursement policies.
Concerns about suicide prevention strategies come as national statistics show suicide is on the rise. In 2022, 49,449 people died by suicide, compared with 47,511 deaths in 2019, before the COVID-19 pandemic, according to the Centers for Disease Control and Prevention. Nearly 30% of people who commit suicide are admitted to a hospital within one month of their death, the National Institute of Mental Health said in a 2014 report.
The Joint Commission’s survey also found that 37% of hospitals had care teams introduce any patients with suicidal thoughts to a behavioral health professional before discharge, and 30% contacted patients following discharge. Around one-fourth of hospitals developed a plan to restrict patients’ access to medications or lethal weapons post-discharge.
Under the Joint Commission’s National Patient Safety Goals, all accredited hospitals are required to screen behavioral health patients for suicidal thoughts, conduct risk assessments and follow established policies and procedures for counseling and follow-up care.
While Atrium Health's suicide prevention efforts are focused on inpatient behavioral health care, the health system hopes to use its Zero Suicide Initiative to ensure no patients fall through the cracks at any point in their care, said Kate Penny, the initiative's program coordinator. The issue for the Charlotte, North Carolina-based health system is finding a way to get that work done.
“I would love to expand and have multiple clinicians doing this work — it's so important,” Penny said. “But we have staffing issues to deal with. It's an issue of resources and we have various grants in the works to be able to do this.”
For some hospitals, complying with the existing requirements is a challenge as organizations struggle to find the trained clinical staff and community-based resources to assess and follow up with patients, Williams said. It would be best if hospitals expanded their efforts and adopted universal screening policies to cover all patients, not only those with a behavioral healthcare condition, he said.
This is already the process across Corewell Health, which screens each hospital patient for depression, anxiety and suicide.
If a patient indicates they are having suicidal thoughts, Corewell Health provides the individual with direct monitoring, risk elimination and consultation from a social worker and psychiatrist, said Dr. Subodh Jain, vice president and division chief of behavioral health at the Grand Rapids, Michigan-based health system.
Corewell Health's Blue Envelope suicide prevention program, implemented in 2017, led to a 8% reduction in suicide deaths among patients after two years and rates of patient suicide remain below the 2017 statistics.
The health system is determining how to best restrict patient access to lethal weapons, an effort that often requires support from families, community members and patient advocates. Additionally, there is the issue of finding sources of funding for the one-on-one hospital observation and attentive care necessary for patients with suicidal thoughts, Jain said.
“We do it because we feel it’s our responsibility,” he said. “But there are smaller, freestanding hospitals and community agencies who need a lot more support in sustaining those efforts.”
Because suicide prevention activities typically aren’t reimbursable healthcare services, full compliance with related guidelines and standards is often a difficult ask, said Ryan McKenzie, chief operating officer and chief nursing officer for behavioral health services at Phoenix-based Banner Health.
“At times there can be a lot of [regulations], so it can be difficult to make sure that you're doing every single thing, but we certainly try,” McKenzie said. “It's mostly having enough time, personnel and money to address those things.”
