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The Joint Commission (TJC) released advisory information to clarify its National Patient Safety Goal about suicide risk reduction, according to Patient Safety & Quality Healthcare. The new and revised elements of performance (EP) regarding NPSG.15.01.01, which become effective July 1, 2019, will apply to all Joint Commission-accredited hospitals and behavioral health care organizations.

EP 3 requires suicide risk assessments include a combination of risk factors such as “individual, biological, psychological, familial, community, cultural, and/or social characteristics or factors that may contribute to the risk of suicide.”

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According to a new FAQ provided by TJC a combination of risk factors may include:

  • Family history of suicide
  • Family history of child maltreatment
  • Previous suicide attempt(s)
  • History of mental disorders, particularly clinical depression
  • History of alcohol and substance abuse
  • Feelings of hopelessness
  • Impulsive or aggressive tendencies
  • Cultural and religious beliefs (e.g., belief that suicide is noble resolution of a personal dilemma)
  • Local epidemics of suicide
  • Isolation, a feeling of being cut off from other people
  • Barriers to accessing mental health treatment
  • Loss (relational, social, work, or financial)
  • Physical illness
  • Easy access to lethal methods
  • Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal thoughts

There are also assessing protective factors posted by TJC, which EP 3 requires the suicide risk assessment to incorporate. Protective factors are “characteristics associated with a lower likelihood of negative outcomes or that reduce a risk factor’s impact. Protective factors may buffer individuals from suicidal thoughts and behaviors.” Protective factors may include, but are not limited to:

  • Safe, secure, monitored environment (e.g., inpatient hospitalization)
  • Receiving clinical care for mental, physical, and substance abuse disorders
  • Easy access to a variety of clinical interventions and support for help seeking
  • Family and community support (connectedness)
  • Support from ongoing medical and mental healthcare relationships
  • Skills in problem solving, conflict resolution, and nonviolent ways of handling disputes
  • Cultural and religious beliefs that discourage suicide and support instincts for self-preservation

According to TJC FAQ, “Psychosocial changes, such as sudden loss of a loved one, broken relationships, financial hardship, etc., can also trigger self-harm behaviors. These patients may also be at risk for suicide, therefore, it is important for clinicians to properly assess these individuals for suicidal ideation as part of their overall clinical evaluation, when indicated.” NPSG15.01.01 EP 3 requires use of an “evidence-based process to perform suicide risk assessment of individuals who have screened positive for suicide ideation.”

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