Caring for Patients Who Need Further Mental Health Evaluation

When patients are found to be at risk for suicide, they need further evaluation and compassionate care. Patients should be praised for talking about thoughts they usually keep to themselves. They should be listened to openly and patiently, without judgement. No one can be “convinced” out of suicidal thoughts, attending to the patient in a caring and compassionate way may help them feel less alone with their thoughts and struggles.

Example phrases include:

• "Thank you for telling me how you’re feeling. It was very brave to share those thoughts."
• "I am here to help you; you don’t have to go through this alone."

Utilize trauma-informed care principles when talking with youth and families about suicide. Be careful not to rush the conversation and choose words carefully to avoid making the patient or parents/caregivers feel blame or guilty about the suicidal ideation or behaviors.

Example phrases include:

• "It was very brave of you to share these thoughts: thank you for telling me."
• "I want to connect you to a colleague of mine who is trained in mental health and can work with you. I’ll help you and your parent/caregiver make an appointment at their clinic."
• "I also want to talk to you about some steps we can take now that’ll help keep you safe in case you have thoughts of suicide in the future."

Talk with parents/caregivers about warning signs to watch for in their child, including significant changes in behavior, decreases in social engagement or activities, giving away possessions, or talking about wanting to die or feeling like a burden. (See the Risk Factors, Protective Factors, and Warning Signs section of this Blueprint for more information.)

Provide brief intervention and support patient safety

• Refer the patient to an outpatient mental health provider when clinically indicated by the brief suicide safety assessment
• Conduct safety planning with the family, and counsel about reducing access to lethal means
  • Make a safety plan with the patient and parent/caregiver that can be activated as needed
  • Talk with patient and their family about access to lethal means
• If the brief suicide safety assessment confirms suicide risk, ask the parent/caregiver if they feel that they can keep their child safe at home. If they say no, this may influence your decision about the next steps for the child’s care, meaning you may not be able to send them home with parent. In these rare situations, you may need to send family to the ED
• For full details, see Brief Interventions that Can Make a Difference

Connect family to outside resources

• Give patient and their parent/caregiver the 988 Suicide and Crisis Lifeline and Crisis Text Line resources upon discharge or leaving the clinic
• Provide parents, caregivers, and families with resources to support them:
  • AFSP: Teens and Suicide- What Parents Should Know
  • Seize the Awkward
  • National Alliance on Mental Illness: Family Members and Caregivers
• Share resources with the family to help them speak openly with each other about mental health and suicide, such as AFSP’s #RealConvo guide or #BeThe1To
• For full details, see Brief Interventions that Can Make a Difference.

Follow up

• Schedule a follow up with patient within 72 hours, or as soon as possible, for a safety check and to determine whether they were able to obtain a mental health appointment
• If a mental health appointment is not possible, consider telehealth or having the patient come back to your office to check in with you until they are evaluated by a mental health clinician