Suicide Screening, Risk Assessment, and Lethal Means Counseling During Zero Suicide Implementation

Area of Science:

• Healthcare quality improvement
• Public health initiatives
• Suicidology

Background:

• Zero Suicide (ZS) is a framework to improve identification and mitigation of suicide risk.
• Implementation of ZS clinical practices varies across different healthcare settings.
• Understanding current practice patterns is crucial for optimizing suicide prevention strategies.

Purpose of the Study:

• To measure the implementation of Zero Suicide (ZS) clinical practices.
• To assess the rates of suicide risk screening, risk assessment, and lethal means counseling.
• To compare these practices between mental health specialty and primary care settings.

Main Methods:

• Analysis of data from six health care systems (2010-2019).
• Inclusion of members aged 13 years and older (N=7,820,524 patients).
• Estimation of proportions for screening, risk assessment, and lethal means counseling.

Main Results:

• In 2019, suicidal ideation screening occurred in 27.1% of mental health visits and 2.5% of primary care visits.
• Positive screening rates were 10.2% in mental health vs. 3.8% in primary care.
• High-risk patients received risk assessment (76.8% mental health, 43.2% primary care) and lethal means counseling (82.4% in both settings).

Conclusions:

• Significant variation exists in ZS practice implementation across health systems.
• Opportunities for improvement include expanding screening beyond regular visits.
• Integrating risk assessment and lethal means counseling in primary care post-screening is recommended.