Buppert made some observations and recommendations when dealing with a suicidal patient.

Failures in dealing with the suicidal patient:

(1) failure to screen

(2) failure to adequately treat

(3) failure to monitor

(4) failure to follow-up

(5) failure to perform an environmental survey in the health facility to remove lethal means of committing suicide (anchor points, potential ligatures, chemicals, etc)

(6) failure to protect in other ways

(7) failure to adequately document

(8) failure to meet other standards of care

(9) failures in staff training


All patients should be screened for depression and risk of suicide using a reliable screening tool.


If a patient has a positive screen then:

(1) Obtain additional information (medical records, family, friends), looking for factors that may indicate significant risk of suicide.

(2) Take action to improve the safety of the patient and generate a safety plan.

(3) Follow-up with the patient within the next 48 hours.

(4) Engage the patient in writing up an agreement that states the goals of treatment.

(5) Refer the individual to a mental health specialist.

(6) Have an alternative provider available to avoid any interruption in care.

(7) Have a means to admit the person to inpatient care if necessary.

(8) Provide the number for the National Suicide Prevention Hotline (1-800-273-8255, 1-800-273-TALK).

(9) Document details of the above steps. Follow-up visits should track the severity of the condition over time in relation to interventions.

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