New tools to help providers assess and treat potentially suicidal patients are available thanks to a collaboration between the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) and the Department of Veterans Affairs (VA).
The tools are based on VA and Defense Department clinical practice guidelines issued last year. The tools integrate the latest evidence-based practices into recommendations on warning signs, protective factors, safety planning and effective treatments.
The suicide risk clinical guidelines were cited as an example of how to expedite the adoption of new research by providers in a recent report, Developing a Research Strategy for Suicide Prevention in the Department of Defense, by the Rand Corporation. So-called bench-to-bedside delays in translating medical research into clinical care are a challenge for the health system both inside and outside the military.
The tools, which primary and specialty care providers can use without having to memorize the 190-page clinical practice guidelines, will hopefully facilitate wider adoption of the guidelines, said Cmdr. Angela Williams-Steele, clinical psychologist and chief of evidence-based practices at Deployment Health Clinical Center, a DCoE center.
“Providers won’t always have time to thumb through a lengthy guideline to find what they need,” she said.
The first tool, the “Suicide Risk Provider Pocket Guide,” is for providers. It briefly explains guidelines and decision aids for primary and specialty care providers to help them recognize symptoms of suicidal risk, treat and manage them.
The second tool, a “Safety Plan Worksheet,” is a provider-driven tool completed with the patient. Although it seems like a simple idea, the worksheet is crucial because it encourages a partnership between the patient and doctor to help keep the patient safe, Williams-Steele said.
“When someone feels suicidal, his mind may not be clear. He doesn’t know who to reach out to,” she said.
The patient can use the completed worksheet as a quick reference guide to identify stressful triggers and warning signs, who to contact for support, and where to go with questions.
Although the worksheet empowers patients to participate in their care, patients should not attempt to fill out the worksheet themselves, she emphasized. When the patient and doctor work together, the worksheet acts like a prescription, a medically-recognized reminder to the patient that his pain is treatable and that he can take practical steps to minimize risk and access the care he needs. Meanwhile, the doctor also keeps a copy of the worksheet to include in the patient’s electronic medical record.
The suite of tools also includes brochures, one for patients and another for family members or battle buddies. Patients and family can pick them up from a provider if they have concerns about a loved one’s behavior.
“Suicide Prevention: Overcoming Suicidal Thoughts and Feelings” educate patients on risk management, strategies to build inner sources of strength, recognizing warning signs, effective coping strategies and the importance of engaging actively in treatment.
“Suicide Prevention: A Guide for Military and Veteran Families” teaches about suicide warning signs, accessing care, appropriate treatments and ways they can best support a loved one who is suicidal or in crisis.
The tools are available for download at the US Army Medical Department website (under the Health Care Team menu on the left) and the Department of Veterans Affairs website. Print copies of the tools will be available for order in 2015.