continues or is easily rekindled in the days and weeks that follow leading to

Continues or is easily rekindled in the days and

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continues or is easily rekindled in the days and weeks that follow, leading to heightened rates of suicide during this post acute care period. However, as is noted in the National Strategy for Suicide Prevention, “All too often the assump- tion is that individuals are no longer at risk for suicide once they are discharged from inpatient hospital or institutional settings.” (DHHS, 2001) Yet, despite the fact that those who attempt suicide and others experiencing a suicidal crisis who are seen in the health care system are a high risk population going through a clear high risk period, there have been few systematic suicide prevention efforts in the United States that have focused on this population during this time pe- riod. Elevated post discharge rates of death by suicide, suicide attempts, and readmissions to acute care services have been repeatedly documented, but this has not been matched by proportionate prevention efforts. Moreover, as this report makes clear, not only has the need been shown to be unmistakable, but there are also promising interventions that can be utilized. In fact, the only two randomized controlled trials in the suicide prevention literature that have shown a reduction in the number of deaths by suicide have both involved following up with high risk populations after discharge from acute care services (Motto and Bostrom, 2001; Fleischmann et al., 2008). The report makes a large number of recommendations for both practice and research. While not everyone may agree with every recommendation, there are core recommendations that are key for behavioral health systems if they are to be designed in a way to optimize their suicide prevention potential and maximize the number of lives that can be saved. These include the establishment of standards for the provision of prompt outpatient care for those who attempt suicide and oth- ers at high risk who are discharged from acute care settings. Here the Veterans Administration is providing national leadership. A second is the need for active outreach and/or case management following discharge. Here the report highlights a number of promising practices ranging from the use of Apache community workers to reach out to those at high risk after discharge, to the use of community crisis centers through the National Suicide Prevention Lifeline to provide phone and text-based outreach, to the VA’s use of “caring letters” and the utilization of facility based suicide prevention coordinators. We have known for many years that Assertive Community Treatment was an evidence-based practice that could improve outcomes and prevent readmissions through
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Continuity of Care for Suicide Prevention and Research 4 assertive post discharge outreach. The adaptation of similar principles to high suicide risk popula- tions could also be of great benefit.
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