1. The Significance of Follow Up Post Discharge
David Eric Lopez, MA

2. Objectives
Describe risk and the occurrence of post discharge suicidal behavior.
Discuss how emergency departments, crisis stabilization centers and inpatient treatment facilities can address risk prior to discharge.
Recommend prevention measures for reattempt of suicide and subsequent hospitalizations.

3. Increased Risk Post Discharge
The risk for a reattempt of suicide is highest during the first 30 days after discharge of a suicidal crisis, attempt or inpatient treatment facility(John S Richardson, 2014).
Most post discharge suicide deaths occur with the initial two weeks of discharge(Davidson, 2005).
Without follow up support, re-hospitalization high within initial 30 days of discharge (Richardson, 2014).

4. Reasons for increased risk
During inpatient treatment, research shows that depression lifts however hopelessness persists which is a high contributive factor to suicide.
Individuals upon discharge can feel alone, depressed and confused.
They likely return to the same host environment, same social support system and life stressors in the community prior to the suicidal attempt.
There is reduced oversight.

5. Barriers for clients after discharge
Inappropriate or Unidentified Care Referral
Referral to an agency which is not in line with clients needs.
Gaps in available care;
Limited resources in rural areas.
Time duration until follow up appointment.

6. Who’s conducting follow up contacts post discharge?
Who provides follow up contact to clients post discharge?
Gaps in service and time between discharge and their follow up appointments contribute to an increased risk in suicide and costs.
Clients who do not receive a follow up contact are likely to not attending any appointments.
Research shows as many as 70% of those who attempt suicide never attend their first appointment.

7. Follow up support and assistance for clients, post suicidal crisis/attempt
Follow-up is an impactful and cost-effective method of suicide prevention. Research shows that follow-up with people recently discharged from an Emergency Department, inpatient setting or a hotline caller has positive results for both those receiving care and those providing it.

8. Crisis hotlines are uniquely positioned to provide follow up care.
Provide 24/7 access to staff trained in suicide assessment and intervention.
Assess for risk of suicide, provide support, offer additional referrals, develop a safety plan, and dispatch emergency intervention, if necessary.
Intervene when a caller is not willing or able to ensure their own safety.

9. Recommendation to improve discharge process.
Structured, consistently applied protocols are essential for an effective follow up program.
As part of the discharge plan offer a follow up contact.
Obtain consent early in the patient’s care to ensure a plan is in place. Ensure the patient has a clear understanding of the follow-up service.
Follow-up care provides a safety net between contacts, ensures continuity of care, and continues the assessment and management of risk.
Inform the patient what that follow up contacts entails.

10. Discharge plan should include
Individual safety plan identifying protective factors.
Referral to treatment provider (seen in 7days best practice)
Identify sources of supports and willingness and ability to provide support.
Give patient and family instruction on suicide and risk after D/C and thereafter.
Give clear instructions on how to access crisis intervention and other sources of help.
American Association of Suicidology (2005)

11. Initial follow-up
Follow up is conducted within hours following a suicidal crisis or discharge from treatment facility.
Follow up includes the following:
Review of safety plan and possible revision if necessary
Review discharge plan and upcoming appointments
Problem solving of obstacles and barriers to obtaining treatment
Support clients well being
Instill hope for a better tomorrow

12. Subsequent Follow Up
After the initial follow up, an additional follow up is provided.
Reviewing the same elements of the first initial contact.
Research shows additional follow up contacts continue to reduce suicidal behavior(John S Richardson, 2014).

13. The Significance of Following Up
Follow ups greatly reduce the risk of a reattempt and should be part of every discharging treatment facility.
Discussing follow-up care at the right time can save lives and hospital resources, and support those in need as they continue their journey towards recovery.
Allows us as a community to engage in a proactive manner and supporting the clients throughout the process.

14. References
Comer, R. J. (2015). Abnormal Psychology. Ney York : Worth Publishers .
Elizabeth A Schilling, P. M. (2014). "Signs of Suicide" Shows Promise as a Middle School Suicide Prevention Program . Suicide and Live-Threatening Behavior,
Janet Kemp, R. P. (2012). Suicide Data Report, 2012 Department of Veterans Affairs Mental Health Services Suicide Prevention Program. Department of Veterans Affairs .
John S Richardson, M. T. (2014). The Return on Investment of Post discharge Follow-Up Calls for Suicidal Ideation or Deliberate Self Harm. Psychiatric Services IN Advance ,
National Institute of Mental Health. (2017, October 21). National Institute of Mental Health Suicide. Retrieved from National Institute of Mental Health:
Sally C. Curtin, M. M. (2016, October 21). Centers for Disease Control and Prevention. Retrieved from National Center for Health Statistics :
SAMHSA: Reachel Lipari and Kathryn Piscopo, RTI International: Larry A Kroutil and Gretta Kilmer Miller . (2015). Suicidal Thoughts and Behavior among Adults: Results from the 2014 National Survey on Drug Use and Health.
Steven D. Vannoy, P. M. (2016). Suicide After Evaluation for Involuntary Psychiatric Commitment-Who gets them and what influences survival time. The American Association of Suicidology ,