Management of Patient Who Attempted Suicide

Immediate Risk Assessment

The American Academy of Pediatrics recommends that patients who have attempted suicide require immediate psychiatric evaluation to determine if inpatient hospitalization is necessary, with the decision based on ongoing suicidal intent, psychiatric illness severity, and availability of adequate monitoring and follow-up care 1, 2
High-risk indicators for psychiatric hospitalization include persistent wish to die, continued suicidal intent, high-lethality attempt, current agitation, inability to engage in safety planning, serious depression, active substance use disorder, low impulse control, inadequate support system, and family unwilling to commit to counseling or monitoring 1, 2, 3

The American Academy of Pediatrics recommends admitting patients to a psychiatric facility if any high-risk indicator is present, as this provides a protected environment for complete medical and psychiatric evaluation with initiation of therapy in a controlled setting 1, 2
Involuntary commitment should be used if the patient or family refuses necessary hospitalization, as most states allow physicians to hold patients for brief periods when the patient has a mental disorder and is at immediate risk of harm to self 4

The American Academy of Pediatrics recommends removing all firearms from the home immediately, as simply having a gun in the home doubles youth suicide risk, and parents consistently underestimate children's ability to access locked firearms 5, 4
A structured safety plan should be developed collaboratively with the patient and family, including warning signs and triggers, coping strategies, healthy distraction activities, social support contacts, professional crisis resources, and a means restriction plan 6, 7, 9, 5, 2

The American Academy of Pediatrics recommends arranging mental health evaluation during or immediately after the initial visit, with options including same-day appointment with a mental health professional, emergency department transfer, or direct hospitalization 1, 2, 3
Ongoing monitoring is crucial, with maintenance of contact even after psychiatric referral, collaborative care, closely-spaced follow-up appointments, flexibility in arranging crisis appointments, and follow-up calls as part of the safety planning intervention 1, 3, 6, 7, 9

Cognitive-behavioral therapy (CBT) reduces the risk of post-treatment suicide attempt by half compared to treatment as usual, by helping identify and change problematic thinking patterns, and is effective for reducing suicidal ideation and behavior 3
Dialectical behavior therapy (DBT) reduces both suicidal and non-suicidal self-directed violence, by combining CBT, skills training, and mindfulness techniques to develop emotion regulation, interpersonal effectiveness, and distress tolerance 3

Discharging patients without ensuring means restriction, relying on no-suicide contracts, underestimating access to locked firearms, assuming low risk based on method lethality, and discharging without confirmed psychiatric follow-up are critical pitfalls to avoid 5, 4, 2