By Stacey Paul, Project Director, Clinical
Gina Malfeo-Martin, Associate Director, Standards Interpretation
Scott Williams, Director, Department of Research
Suellen Daum, Patient Safety Specialist, Office of Quality and Patient Safety
Kenneth Hebert, Associate Director, Standards Interpretation
In 2020, COVID-19 was listed as the 3rd leading cause of death, dropping suicide to the 11th overall cause of death.
However, this figure is deceiving as most mental health experts have attested to a probable increase in suicides due to social isolation, lockdowns, additional anxiety over health or finances, and other pandemic-related reasons. It takes up to 11 months after the end of the calendar year for the Centers for Disease Control and Prevention (CDC) to release final mortality data. Pediatric suicides were especially concerning before the pandemic. Emergency room visits for suspected suicide attempts among girls between the ages of 12 and 17 increased by 26% during summer 2020 and by 50% during winter 2021, compared with the same periods in 2019, according to the CDC’s Morbidity and Mortality Weekly Report on June 11, 2021.
A large proportion of individuals who ultimately die by suicide have contact with a health care provider in the year leading up to their death. And the period immediately following discharge from a health care facility can be a particularly risky time for patients struggling with mental health issues. Health care providers are often in a unique position to assess and identify individuals who may be at risk for suicide and to take actions that may improve outcomes for those individuals.
National Patient Safety Goal on Suicide Prevention
The Joint Commission has long prioritized suicide prevention as core to our mission of advancing patient safety in our accredited health care organizations and that has not changed during the pandemic.
Since publishing Sentinel Event Alert Issue 7, “Inpatient Suicides: Recommendations for Prevention” in 1998, The Joint Commission has worked with health care organizations on conducting rigorous risk assessments to help make their health care environment safer and prevent suicides. National Patient Safety Goal NPSG.15.01.01 was introduced in 2007 to further focus preventive efforts.
In 2017, to provide guidance to customers and surveyors on what constitutes adequate safeguards to prevent suicide, The Joint Commission assembled an expert panel with representatives from provider organizations, experts in suicide prevention and design of behavioral health care facilities, Joint Commission surveyors and staff, and representatives from the Centers for Medicare & Medicaid Services (CMS). A formal consensus process was used to develop recommendations to address the most debated and contentious issues related to environmental hazards.
In addition, the Joint Commission revised NPSG 15.01.01, effective July 1, 2019 for Hospital and Behavioral Healthcare and Human Services programs, and July 1, 2020 for Critical Access Hospital program, based on recommendations from its Technical Expert Panel and current evidence-based research. The former goal took a high-level approach to suicide prevention in health care organizations and, as such, had been limited in its objective of helping organizations improve their processes and environments for individuals at risk for suicide. The revised goal, which now is more specific and instructional, aligns with current research and the expert panel recommendations.
The objective of this National Patient Safety Goal is to drive organizations to implement suicide prevention programs that will improve safety for the individuals in their care. Nobody predicted a global pandemic within months of the implementation of this standard, but accredited organizations have demonstrated a commitment to preventing suicides, even in today’s uncertain environment.
Leading Practice Adoption
Some organizations have gone above and beyond Joint Commission requirements in their suicide prevention programs.
These accredited organizations are implementing programs recommended by suicide prevention leaders such as the American Foundation for Suicide Prevention, Suicide Prevention Resource Center, Zero Suicide Institute and the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration. Some of the concepts that have been successful include, but are not limited to:
- universal suicide risk screening in health care environments
- suicide risk screening via telehealth
- community-specific education and interventions
While the Joint Commission is not asking accredited organizations to take any actions outside of what’s required by the National Patient Safety Goal, we are heartened that many are going the extra mile during such a challenging time. Suicide is still one of the most common sentinel events reported to The Joint Commission, and we are honored to partner with health care organizations in proactively identifying the individuals in their care who are at risk for suicide and implementing strategies to keep those individuals safe until they can receive the care, treatment and/or services needed.
It is important for healthcare organizations to keep focused on suicide risk reduction amidst the ongoing pandemic. The Joint Commission is dedicated to supporting healthcare organizations in implementing and sustaining effective suicide risk reduction programs. Please visit our Suicide Prevention Portal for additional resources.
Gina Malfeo-Martin, MSN, RN, is currently an Associate Director in the Standards Interpretation Group for the Behavioral Health Care and Hospital Psychiatric Programs at The Joint Commission. Certified in psychiatric-mental health nursing by the ANCC, Ms. Malfeo-Martin has over 15 years of psychiatric-mental health nursing experience. She has dedicated her nursing career to psychiatric-mental health and has had a variety of nursing roles within behavioral health. Prior to joining The Joint Commission, she served as a clinical nurse educator and, subsequently, a manager of inpatient behavioral health where she was responsible for clinical, operational, and financial oversight.
Stacey Paul, MSN, RN, APN, PMHNP-BC is a project director, clinical in the Department of Standards and Survey Methods at The Joint Commission. She has experience in inpatient, partial hospitalization, residential, and outpatient settings in psychiatry. Prior to this position, she has worked for Lurie Children’s Hospital, Children’s Home and Aid, and Mount Sinai Hospital. Most recently, she has worked as a nurse practitioner in Psychiatry at Alexian Brothers Behavioral Health Hospital.
Scott Williams, PsyD, is Director of the Department of Research at The Joint Commission. In this role, he is responsible for the development and coordination of internally and externally funded research projects that promote The Joint Commission’s mission to improve the safety and quality of health care. Dr. Williams’ work has been published in the New England Journal of Medicine, Circulation, International Journal on Quality in Health Care, Psychological Reports and other peer-reviewed journals.