Connect with mental and behavioral health resources in your community
Prior to implementing a suicide prevention protocol in your clinic, it is critical to establish a list of mental and behavioral health providers that you can refer patients and families to.
Ensure that the providers on your list are:
- Accessible to your patient community
- Affordable (eg, accepts public/private insurance or has a sliding-scale fee system)
- Multidisciplinary, diverse, and culturally and linguistically representative of your patient population
- Experience working with children and adolescents
- Able to assess for suicide risk and plan for safety
If possible, establish a connection with these providers prior to implementing the suicide prevention protocol in your clinic. Tell them you are going to start screening for suicide risk and ask if they can accommodate any of your patients that need further evaluation. Building these connections will allow you to make a warm hand-off for patients in the future.
What to do when facing a lack of community resources
Many areas lack sufficient access to mental and behavioral health supports. This is a systemic challenge that requires long-term, appropriately resourced solutions.
When mental health care is unavailable, clinicians and office staff can help families consider alternative options such as telehealth services, school-based behavioral health services, or follow-up appointments with the pediatrician until mental health services can be arranged.
Alternative strategies include:
- Safety planning and lethal means safety counseling can be conducted in your practice during the visit to help ensure safety during long wait times for mental health intervention
- Telehealth can be used to increase youth access to mental and behavioral health care
- Promote telehealth access to all families by using a modality that is mobile-friendly and using multiple languages, interpreters, and assistive technology to facilitate visits
- Note: Accessibility of telehealth is dependent on the availability of reliable broadband and network access and state laws, which may vary by geographic region. For an overview of state telehealth laws, click here
- School, community, or tribal-based behavioral health services may be available
- Pediatric health clinicians can consider working with Pediatric Mental Health Care Access Programs (PMHCA), also called Child Psychiatry Access Programs (CPAP). These are collaborative programs that provide training and support to primary care providers related to addressing mental health conditions in practice. Please see the National Network of Child Psychiatry Access Programs to identify child psychiatry consultation programs across the country.
For more information, see How to Prepare your Clinic or Health System for a Suicide Prevention Program.
Understand the difference between screening versus assessment – you need both!
Identifying youth at risk of suicide requires both screening and assessment. These are two distinct parts of the suicide prevention process. Both are necessary.
Suicide risk screening is a very rapid way to identify someone who needs further assessment for suicide risk. It can be completed through a variety of methods, including verbal asking, self-report paper/pencil forms, or computer questionnaires. Because we do not have tools that can predict who will die by suicide, anyone who is detected “at risk” by a suicide risk screening tool will require a brief suicide risk assessment to follow up on the tool.
Suicide risk assessment is a comprehensive evaluation to confirm suicide risk, assess risk and protective factors, and guide next steps. It may also assess other mental health symptoms and warning signs such as excessive alcohol or other substance use. Parents, families, and caregivers can be important corroborators when assessing a young person’s suicide risk and should be included, when appropriate and available.
American Academy of Pediatrics