Assessing Risk and Preventing Suicide via Telehealth

A common concern for clinicians who are now treating clients via telehealth includes how they can properly assess and address suicidal ideation. In the past, telehealth was an optional method of providing treatment, yet the coronavirus pandemic has made a switch to this technology necessary to protect clients’ physical health while supporting their mental health. However, the concept of not being in the same physical space as a client who is expressing suicidal thoughts or actions can be unnerving. How can this situation be managed in a virtual environment?

Thankfully, a wealth of resources and best practices are available to help clinicians navigate these scenarios. Research has shown that with proper crisis planning protocols adapted to the telehealth environment, client risk for suicide can be mitigated and can even reduce client and clinician anxiety, enhance accuracy and reliability of suicide assessments, and support client safety.

Establishing an organizational protocol

Prior to any client beginning telehealth services, it is critical that your organization has in place a crisis risk protocol. Lauren Lashbrook, Director of Strategic Partnerships at innovaTel Telepsychiatry, noted in a recent Relias webinar, “When initiating treatment with a patient, we establish a crisis plan that includes the local crisis services program, the local ER and 911 options. The patient agrees to utilize crisis services at the direction of the treating clinician.”

In practice, a crisis protocol for telehealth is not going to vary much from the crisis protocol you would implement for in-person treatment. However, there are a few key elements that you should keep in mind:

• Use evidence-based tools. Make sure you are using an evidenced-based assessment for suicide risk as well as an evidence-based safety planning protocol, such as the Brown-Stanley Safety Plan.
• Obtain the client’s local EMS information. Document the client’s local emergency medical response information and the closest paramedic location (using a nonemergency number or through a county website).
• Identify clients’ local social supports. With the client, curate a list of family members, friends, or community members who can be called upon to support a client’s safety during crisis. Obtain the necessary authorizations for release of information for all these contacts.
• Create a plan for maintaining contact. Discuss a plan for reestablishing contact if there is a disruption in the telehealth service. If technical issues arise during a crisis, you and your client will want a predetermined plan for staying in contact via phone until emergency supports arrive.
• Broader assessment of suicide risk may be indicated. Given the current stressful events, you may need to assess more clients for suicidal ideation. Express your concern and ask clients directly about any recent suicidal thoughts or behavior.

Adapting crisis plans for telehealth

Consider ways you could adapt each individual crisis plan to effectively work with clients who are struggling with suicidal thoughts. The Center for Practice Innovations created a telehealth tip sheet for managing suicidal clients during the coronavirus pandemic that includes the following:

• Request the client’s location at the start of every session. Even if you are conducting telehealth with a videoconferencing platform, it is ideal to have the location (address, apartment number, etc.) of your client available at all times.
• Be specific when listing adaptive options for social support. For example, calling a good friend on the telephone may yield better results than using a chat room on social media, which can be distressing.
• Assess for the emotional impact of the pandemic. Current requirements to socially distance can lead to a wide array of situations that can exacerbate suicidal feelings. Recognize the impact that social distancing can have on decreased social support, increased anxiety, and disruption of routine.
• Virtual contact may feel different from other means of communication. Discuss the methods of remote contact that best suit your client’s needs. For example, some clients may prefer texting to disclose feelings of distress, but videoconferencing for distraction.
• Safety planning will keep clients physically healthy. Emphasize with your clients that adhering to a safety plan is especially important now so they can avoid having to go to the emergency department or another medical facility.

Prevention is possible

In addition to these safety planning steps, always provide your clients with local contacts for accessing emergency mental health services. You should also provide national numbers they can access in case they are not able to reach out to you. The National Suicide Prevention Lifeline offers a 24/7 hotline as well as a chat page and support via text messaging.

It is critical for clinicians to also attend to their own mental well-being during this time. Social isolation and stressful world events can easily lead to anxiety, depression, and burnout among clinicians. Make sure when working with suicidal clients that you allow periods of coverage and time off and inform clients in advance when you take time away from practicing.

Remember, suicide is preventable, even during a global pandemic. During these difficult times, you have the opportunity as behavioral health clinicians and providers to address suicidal ideation in your clients and to mitigate the risk of suicide. Our Suicide Prevention solutions are available to help you and your team achieve this goal.

If you are in crisis or know someone who is, please call or share the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 741741.