Evaluating Barriers to Patient Implementation of Suicide Prevention and Safety Plans

Suicide is a major public health problem in the US. In fact, it is the tenth leading cause of death. Incorporating suicide prevention and safety plans (SPSP) into patient care provide strategies for individuals struggling with suicidal ideation and behaviors. These strategies identify individual risk factors, warning signs, coping skills, social support, and community resources in order to promote safety. The aim of this project is to analyze barriers that prevent implementation of these suicide prevention and safety plans among patients readmitted to an inpatient psychiatric unit 30 days after initial discharge. Objectives of the project included (a) exploration of how patients readmitted within 30 days use SPSP after discharge, (b) development of questions for an interview to assess barriers to successful implementation of SPSP in readmitted patients, (c) evaluation of data gathered during the interview, and (d) presentation of findings and proposed changes to the unit medical director and physician group. A literature review on the topic of suicide prevention found that the collective efforts of individuals, healthcare professionals, and organizations reduce suicide. Individuals with suicidal thoughts and behaviors require hospitalization to inpatient units for safety and evaluation. Safety planning is one intervention incorporated as part of a long-term psychotherapy approach in treating suicidal patients. Higher quality SPSPs have led to fewer psychiatric hospitalizations. Readmissions to inpatient units around the country continue even with SPSPs in place at discharge, leading to hospital financial liability. There is a gap in knowledge regarding the barriers individuals encounter in using their SPSP and in how to increase the effectiveness of this intervention. Implementation of this project included:(a) conducting a literature review of current SPSP practices to determine the need for this project; (b) creating questions for a patient-centered interview, with approval of the DNP chair; (c) using the approved questions during patient interviews to obtain a saturation of information regarding SPSP use; (d) disseminating and presenting results to the psychiatric group over the inpatient unit, and (e) presenting recommendation to improve SPSP efficacy. Results of the study indicated many patients did not use their SPSP during hospitalization, misplaced their SPSP or did not use their SPSP during times of distress. This may have contributed to re-hospitalization. Patients felt that greater emphasis, specifically implementing strategies during their hospitalization, could improve the overall effectiveness and usefulness when discharged from the hospital. With a better understanding of the barriers to individual use of SPSP, psychiatric and mental health teams can begin the process of improving this vital intervention. Improvement in safety planning can, and will, lead to individuals being more prepared to meet the challenges they will encounter in their daily lives.