How to Refer Patients who are Suicidal K
nowing how to appropriately refer a patient who self-identifies as suicidal, or whom you determine to be depressed, can be perplexing—made even more difficult during the COVID-19 pandemic. While standard procedure has always been to refer suicidal individuals to immediately seek care in an emergency department, those who have not contracted COVID-19, including those with suicidal thoughts, may be hesitant to seek care in emergency rooms. You have the opportunity now to put tools and resources in place to address behavioral health concerns before they become crises. So, what to do with the patient who you are concerned may be suicidal? AHCCCS recommends the following: Begin with a best practice screening tool. There are several available; two you may want to consider: • w The Columbia Suicide Severity Rating Scale (C-SSRS) or the Suicide Assessment Five-Step Evaluation and Triage (SAFE-T). If you determine the patient is acutely suicidal: w Do not leave patient alone. Utilize EMS and/or contact the crisis line in your region to assist. If you determine the patient is not acutely suicidal: w Identify a friend or family member who will be physically present with them until they can get into care. w Encourage the patient, and any family or friends who may be present, to immediately remove firearms and unnecessary medications from the home. Follow up with your patient. Significant research shows that individuals treated for suicidal ideation who receive a phone call, text message, or letter within two weeks of being seen are less likely to die by suicide than patients who don’t receive such messages.
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ARIZONA PHYSICIAN | Fall 2020
Additional Resources: • Arizona 2-1-1 https://211arizona.org/ • ResilientArizona.org connects any individual in crisis during COVID-19 to help regardless of insurance or citizenship • Teen Life Line phone or text: 602-248-TEEN (8336) • Veterans Crisis Line: 1-800-273-8255 (press 1) • Be Connected: 1-866-4AZ-VETS (429-8387)
CRISIS HOTLINES: Maricopa County served by Mercy Care:
1-800-631-1314 or 602-222-9444 Cochise, Graham, Greenlee, La Paz, Pima, Pinal, Santa Cruz and Yuma Counties served by Arizona Complete Health - Complete Care Plan:
1-866-495-6735 Apache, Coconino, Gila, Mohave, Navajo and Yavapai Counties served by Health Choice Arizona:
1-877-756-4090 Gila River and Ak-Chin Indian Communities:
1-800-259-3449 Salt River Pima Maricopa Indian Community:
1-855-331-6432
By Kelli D. Williams, MPH, State Suicide Prevention Specialist, Arizona Health Care Cost Containment System (AHCCCS), kelli.williams@azahcccs.gov
