Asking About Suicide Is Vital for Healthcare and Suicide Prevention

Everyone involved in medical and behavioral healthcare can help prevent suicide and save lives, just by taking a few moments to ask the right questions. Studies confirm that, in many ways, healthcare providers are uniquely positioned to make a difference.

Nearly 50% of people who die by suicide see their primary care doctor in the month before their death.

Researchers found that about 25% of young adults have suicidal thoughts and approximately 9% carry out a suicide attempt if they have experienced at least one of the following medical conditions: asthma, arthritis, cancer, chronic bronchitis, diabetes, hypertension, gout, lupus, stroke, or thyroid disease. Another study found that 25% of people who die by suicide are seen in the emergency room for nonpsychiatric reasons in the 12 months prior to their death.

The Columbia Protocol Is Helping Healthcare Professionals Save Lives and Target Resources

Asking the right questions to determine suicide risk should be as routine as checking blood pressure — and, with the Columbia Protocol, it’s just as quick. The Columbia Protocol — also known as the Columbia-Suicide Severity Rating Scale (C-SSRS) — also helps optimize healthcare resources by directing people to the right level of care.

The Columbia Protocol is the ideal risk detection tool for healthcare environments because it’s:

  • Simple. Ask all the questions in a few moments or minutes — with no mental health training required to ask them. Anyone can do the asking: doctors, nurses, physician assistants, counselors, or other caregivers.
  • Efficient. Use of the Columbia Protocol redirects resources to where they’re needed most. It reduces unnecessary referrals and interventions by more accurately identifying who needs help — and it makes it easier to correctly identify the level of support a person needs, such as patient safety monitoring procedures, counseling, or emergency room care.
  • Effective. Real-world experience and data show that the protocol has helped prevent suicide.
  • Universal. The Columbia Protocol is suitable for all ages and special populations in different settings and is available in more than 140 country-specific languages.
  • Evidence-supported. An unprecedented amount of research has validated the relevance and effectiveness of the questions used in the Columbia Protocol to identify suicide risk, making it the most evidence-based tool of its kind.
  • Free. The protocol and the training on how to use it are available free of charge for use in community and healthcare settings, as well as in federally funded or nonprofit research. For health/behavioral health care providers there is also no cost or license required to put the Columbia Protocol tools into your EHR/EMR.

“[The Columbia Protocol] allowed us to identify those at risk and better direct limited resources in terms of psychiatric consultation services and patient monitoring.”

Reading Hospital and Medical Center, Reading, Pennsylvania

Success Story

Columbia Protocol Helps Centerstone Reduce Suicide Rate by 65%

Soon after Centerstone, one of the largest not-for-profit providers of community-based behavioral healthcare in the U.S., joined the Zero Suicide campaign in 2012, it made the Columbia Protocol one of the cornerstones of its suicide prevention efforts for its facilities in Tennessee. Zero Suicide, a key concept of the 2012 National Strategy for Suicide Prevention, is a commitment to suicide prevention in health and behavioral healthcare systems.

Centerstone, a multistate provider based in Nashville, Tennessee, treats people for conditions that elevate their risk for suicide. So Centerstone doesn’t pick and choose the people to be assessed; it uses the protocol to screen everyone.

“It’s asked of every client at every service delivery point,” says Becky Stoll, Centerstone’s vice president for crisis and disaster management. “We really act like it’s standard operating procedure.”

The Columbia Protocol screening is embedded into the patient’s electronic health record, and the response is systematic. For example, if the patient’s responses to the questions show that he or she is at high risk, Centerstone sees the patient more frequently, keeps in touch through follow-up phone calls, and enlists his or her loved ones as part of the care team. Centerstone also completes welfare checks if appointments are missed and if its staff members cannot contact the patient.

Just 20 months into its suicide prevention effort at its facilities in Tennessee, Centerstone saw dramatic results: Suicide rates among those patients dropped 65%, from 3.1 per 10,000 people to 1.1. Based on the pilot program’s success, Centerstone is implementing the same system in the three other states in which it has centers: Illinois, Indiana, and Florida.

The C-SSRS in Action

The Columbia Protocol is being used across the whole range of healthcare providers: doctors’ offices, hospitals, behavioral health facilities, drug and alcohol addiction centers, mental health programs, community clinics, and more. The Reading Hospital and Medical Center in Pennsylvania, for example, incorporated the Columbia Protocol into a clinical suicide screening protocol that is a component of assessment for all patients admitted into the acute care hospital setting, regardless of psychiatric history. Here are some other healthcare providers using the scale:

  • Parkland Hospital/University of Texas Southwestern Medical Center
  • Nationwide Children’s Hospital
  • St. Vincent Medical Center
  • New York University Langone Medical Center
  • University of Michigan Health System
  • St. Cloud Hospital Behavioral Health Services
  • Sharp Mesa Vista Hospital
  • University of Louisville Hospital
  • Ascension Health/St. Vincent Health
  • Banner Behavioral Health
  • Trinity Health
  • Carolinas HealthCare System
  • Palmetto Health

How Centerstone Implemented the Columbia Protocol in Its Push for Zero Suicides

Becky Stoll, vice president for crisis and disaster management at Centerstone, describes how the largest not-for-profit provider of community-based behavioral healthcare in the U.S. implemented and integrated the Columbia Protocol into its suicide prevention program.

“Other than during the treatment for a medical emergency, every person contacting medical and behavioral healthcare should be screened for suicide using a standardized, simple tool.”

National Action Alliance for Suicide Prevention’s Clinical Care and Intervention Task Force, 2012