Emergency Rooms Could Cut Suicide Risk in Half With One Simple Step

When someone in psychiatric distress arrives at an emergency room seeking help for suicidal feelings, care providers do what they can to stabilize the patient – but often, that individual falls through the cracks as soon as they leave.

A group of researchers has identified a simple, yet powerful, step that facilities could take to radically reduce the risk of repeated suicidal behavior, helping people get back on track with their lives. And adopting this strategy could be well worth the cost: Subjects provided with their structured intervention were reportedly half as likely to engage in suicidal behavior.

In the United States, where access to mental health services can be erratic, people may struggle to get the care they need even before they feel suicidal. And when they wind up in the ER, the focus is on managing the immediate crisis. Patients may be treated and released, told to get care elsewhere or referred for short-term residential treatment. But without a regular relationship with a mental health provider and access to care, these individuals can start to spiral again.

That’s why the researchers explored a more structured way to help people seeking treatment during times of distress. It starts with a Safety Planning Intervention in the emergency room itself, including a standardized system for screening, evaluation and support. Patients who receive this intervention get access to tools and information they can use to better manage their mental health and access help when they need it. The standardized nature of this intervention helps clinicians track effectiveness.

It’s also very basic, clear and easy to use. You don’t need to be a psychiatrist to work with a patient on an SPI — nurses, social workers, physician assistants and other members of a health care team can administer the plan. This approach reduces barriers of time and cost that could make it challenging to administer. Helping someone identify warning signs of a crisis and develop a plan for what to do if these conditions appear is critical. For example, someone might realize that feeling withdrawn is a bad sign, and her safety plan could include something as simple as phoning a friend.

After discharge, patients receive similarly structured and scheduled follow-up to ensure that they are connected with treatment and stay in touch with providers. This is a critical step; a single Safety Planning Intervention can help, but it won’t provide the long-term monitoring and support that some patients need. This strategy creates a mental health framework that works to address coverage gaps — and, according to the research, it seems to work.

Researchers call this SPI+, and they note that patients receiving this combination of support do much better in terms of reductions in suicidal behavior, seeking and sticking with treatment and use of safety plans when feeling overwhelmed or at risk. SPI+ is particularly important in the immediate aftermath of a suicide attempt or admission to the emergency room for suicidal thoughts, when people can be at a much higher risk.

This study took place at Veterans Affairs hospitals, which can be a useful study cohort for a variety of reasons — not least of which are the detailed records. In this case, it was also very apt. Veterans are much more likely to experience mental health conditions, and they’re at an elevated risk of suicide — especially in the case of men. Identifying effective interventions for this high-risk population is an ongoing critical need.

SPI+ could be used anywhere, in hospitals large and small. Hopefully this study will encourage other researchers and health professionals to explore this approach and other interventions in a variety of health care settings, improving the standard of care for anyone in mental health crisis.

If you or someone you know is struggling with thoughts of suicide, you can contact the Suicide Prevention Lifeline for resources and support. 

Photo Credit: Niklas Hamann/Unsplash


Marie W
Marie W2 months ago

Thanks for sharing.

Cindy S
Past Member 7 months ago

doubt that would work

Shirley S
Shirley S8 months ago

Whatever it takes to help these needy people.

Leanne K
Leanne K8 months ago

Certainly sounds worthwhile implementing. Lets hope they are not forced to wait hour and hours.

Chad A
Chad Anderson8 months ago

Thank you.

Winn A
Winn Adams8 months ago


Winn A
Winn Adams8 months ago


Debbi W
Debbi W8 months ago

It would be wonderful is SPI could be used at every ER. I really hope this program spreads. Our local hospital isn't the best, but they do have an attentive group of people working in the ER, who watch people and ask question. They also make follow-up calls, same after surgery.

Anne Moran
Anne Moran8 months ago

SPI+ is a super idea,, as emergency dept. is usually more focused on people coming in there with injuries, or with people who have overdosed, or are in a drunken stupor.. - This kind of help would indeed be beneficiary to those who come in to seek help, because they have lost all will to live.. - Hurry,, implement this in all hospitals, and save those poor souls...

Ann B
Ann B8 months ago

interesting but dont see improvements soon