CONTEXT: Suicide is one of the leading causes of death in the United States. While suicides occurring during psychiatric hospitalization represent a very small proportion of the total number of suicides, these events are highly preventable owing to the controlled nature of the environment. Many methods have been proposed, but no interventions have been tested. OBJECTIVE: To evaluate the effect of identification and abatement of hazards on inpatient suicides in the Veterans Health Administration (VHA). DESIGN, SETTING, AND PATIENTS: The effect of implementation of a checklist (the Mental Health Environment of Care Checklist) and abatement process designed to remove suicide hazards from inpatient mental health units in all VHA hospitals was examined by measuring change in the rate of suicides before and after the intervention. INTERVENTION: Implementation of the Mental Health Environment of Care Checklist. MAIN OUTCOME MEASURE: The number of completed suicides on inpatient mental health units in VHA hospitals. RESULTS: Implementation of the Mental Health Environment of Care Checklist was associated with a reduction in the rate of completed inpatient suicide in VHA hospitals nationally. This reduction remained present when controlling for number of admissions (2.64 per 100 000 admissions before to 0.87 per 100 000 admissions after implementation; P < .001) and bed days of care (2.08 per 1 million bed days before to 0.79 per 1 million bed days after implementation; P < .001). CONCLUSIONS: Use of the Mental Health Environment of Care Checklist was associated with a substantial reduction in the inpatient suicide rate occurring on VHA mental health units. Use of the checklist in non-VHA hospitals may be warranted.
CONTEXT: Suicide is one of the leading causes of death in the United States. While suicides occurring during psychiatric hospitalization represent a very small proportion of the total number of suicides, these events are highly preventable owing to the controlled nature of the environment. Many methods have been proposed, but no interventions have been tested. OBJECTIVE: To evaluate the effect of identification and abatement of hazards on inpatient suicides in the Veterans Health Administration (VHA). DESIGN, SETTING, AND PATIENTS: The effect of implementation of a checklist (the Mental Health Environment of Care Checklist) and abatement process designed to remove suicide hazards from inpatient mental health units in all VHA hospitals was examined by measuring change in the rate of suicides before and after the intervention. INTERVENTION: Implementation of the Mental Health Environment of Care Checklist. MAIN OUTCOME MEASURE: The number of completed suicides on inpatient mental health units in VHA hospitals. RESULTS: Implementation of the Mental Health Environment of Care Checklist was associated with a reduction in the rate of completed inpatient suicide in VHA hospitals nationally. This reduction remained present when controlling for number of admissions (2.64 per 100 000 admissions before to 0.87 per 100 000 admissions after implementation; P < .001) and bed days of care (2.08 per 1 million bed days before to 0.79 per 1 million bed days after implementation; P < .001). CONCLUSIONS: Use of the Mental Health Environment of Care Checklist was associated with a substantial reduction in the inpatient suicide rate occurring on VHA mental health units. Use of the checklist in non-VHA hospitals may be warranted.
Authors: Rebecca B Price; Dan V Iosifescu; James W Murrough; Lee C Chang; Rayan K Al Jurdi; Syed Z Iqbal; Laili Soleimani; Dennis S Charney; Alexandra L Foulkes; Sanjay J Mathew Journal: Depress Anxiety Date: 2014-03-25 Impact factor: 6.505
Authors: Lydia Oeljeklaus; Hannah-Lea Schmid; Zachary Kornfeld; Claudia Hornberg; Christine Norra; Stefan Zerbe; Timothy McCall Journal: Int J Environ Res Public Health Date: 2022-01-28 Impact factor: 3.390