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Texas Health Presbyterian Hospital Dallas began screening all patients for suicide risk on Nov. 14, 2019. Risk levels are classied into three categories. As of mid-May, a total of 159,086 patients have been screened. A total of 2.13% screened for some risk. 3,997 total patients identied with some risk. Some patients were screened more than once. 3 levels of risk
According to Parkland Health data, anywhere from about 41,000- 45,000 screenings are conducted each month between its primary care and emergency departments. Positivity rate of suicide risk is typically around 2%-3% in primary care settings and around 7% in the hospital. Parkland began screening all patients for risk of suicide using stan- dardized and validated tools devel- oped by the National Institutes of Mental Health in 2015, according to representatives from the hospital. At another hospital, ocials with Texas Health Presbyterian Hospital Dallas said universal screening began in 2019. Dr. Kimberly Roaten, director of quality for safety, education and implementation in the Department of Psychiatry at Parkland, said the screening program allows doctors to better identify individuals who are potentially at risk. Simply going through the screening may even reduce risk of suicide, she added. “We opted to screen everyone [and] ask everyone these questions to try to catch more people,” Roaten said. “There are a number of benets to it.” An open dialogue Roaten said Parkland has seen “a lot of attention” over the past seven years as it was the rst major hospi- tal system nationwide to implement a universal screening program. Ahead of the program, Parkland ocials found that many patients who die by suicide have contact with a health care system in the months prior to death. A Parkland news release from September 2016 stated that 77% of people who die by suicide had contact with a primary care pro- vider in the year prior to death, and 40% had contact with an emergency department provider. “We’re able to identify patients [and] individuals who are potentially at risk who we might otherwise miss,” Roaten said. Parkland patients who are iden- tied as being at risk of suicide then receive a full risk assessment, according to Roaten. Patients who are identied to be of high risk receive attention to “promote immediate safety,” including counseling and lim- ited access to means of self-directed violence. In rare instances, Roaten said patients may be hospitalized.
High risk: A total of 2,987 high-risk patients comprised 2% of overall patients screened and 75% of patients with some risk level. Out of them, 82.32% of patients were referred for a crisis clinician evaluation and to complete a safety plan, and suicide precautions were ordered.
Low risk: A total of 759 low-risk patients comprised 0.5% of overall patients screened and 19% of patients with some risk level. Out of them, 32% of patients were referred for a crisis clinician evaluation or to pastoral care.
Moderate risk: A total of 256 moderate-risk patients comprised 0.2% of overall patients screened and 6% of patients with some risk level. Out of them, 74.6% of patients were referred for a crisis clinician evaluation and to complete a safety plan.
SOURCE: TEXAS HEALTH DALLASCOMMUNITY IMPACT NEWSPAPER
Of the 159,086 total people screened, 3,275 people answered yes to a lifetime history of acting on or preparing for a suicide attempt.
According to Roaten, screening for suicide risk has not disrupted hospi- tal workow, nor has it upset patients and families. More hospitals on a local and national scale have become open to the idea of expanding suicide screening practices, she said. At Texas Health Dallas, a total of 159,086 patients as of mid-May had been screened for risk of suicide since universal screening began. Just over 2% of patients screened during that time indicated some risk of suicide. Dr. Gonzalo Perez-Garcia, a psychi- atrist with Texas Health Dallas, said asking patients if they are considering death by suicide does not plant the idea in their heads. “There’s this misconception some- times by the general public that it’s not safe to ask someone if they’re suicidal,” he said. “Studies have shown that is absolutely not true. It is very safe to ask someone if they’re suicidal.” Patients at high risk for suicide at Texas Health Dallas are evaluated by a social worker to determine whether they need to be referred to a clinic or admitted to a hospital, Perez-Garcia said. In some cases, patients at Texas Health Dallas attend a group therapy program. Perez-Garcia said open dialogues with friends and family can also help save lives. “[Asking allows] someone who is suicidal to know that a friend or fam- ily member cares about them, worries
about them and is a safe person to turn to in case thoughts are present or thoughts get worse sometime in the
future,” he said. Outside factors
Calls to crisis hotlines and emer- gency department visits for sui- cide-related risk factors have increased throughout the COVID-19 pandemic, according to Roaten. The full eect of the pandemic on suicide deaths is unknown due to a lag in data collection, she said. However, she said expanded tele- health capabilities and awareness of mental health are benets that came from the pandemic. “I hope that we’re making a dent in the mental health stigma,” Roaten said. “I hope that by having these conversations and talking about how the risk has increased during the pan- demic [it] is increasing the chances that people will be more willing to seek mental health care.” Worsening depression is the No. 1 factor to identify when assessing sui- cide risk, according to Perez-Garcia. But ocials with both hospitals said that a number of health conditions other than psychiatric illnesses could indicate a higher risk of suicide. Texas Health Dallas sta members said chest pain is a nonpsychiatric complaint seen most commonly asso- ciated with suicide. Parkland sta also said that a number of conditions that may indicate a higher risk of
suicide, according to scientic litera- ture. They include certain cancers and conditions with chronic pain. “Patients with chest pain … that is the most common physical symp- tom of patients who mentioned being suicidal,” Perez-Garcia said. “I think that’s something to follow up on. ... That was certainly an interesting thing.” Supporting students Programs to identify and assist chil- dren experiencing depression or risk of suicide are in place in the Dallas and Richardson ISDs. This fall, Dallas ISD plans to debut a new tool called the Patient Health Questionnaire 9, or PHQ9, to better identify and aid students in grades 6-12 experiencing depression. For the 2021-22 school year, Tracey Brown, DISD executive director of men- tal health services, said the district has seen more than 10,000 student referrals for depression, isolation or anxiety.
COMMUNITY IMPACT NEWSPAPER • COMMUNITYIMPACT.COM
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