In the US, a single, number serves as a suicide hotline for the entire country. Starting in July 2022, the number is 988.
Reducing access to lethal means
1. Removing guns is absolutely essential in suicidal patients since 50% of those who die by suicide use a firearm. I have a very low threshold for recommending that.
2. Reducing the amount of medication available is also wise. Of course, the person can buy more over-the-counter medication, but at least removing medication helps with impulsive overdoses.
3. Even if the person needs medication, the family member can keep the bulk of the medication and give the patient one week’s worth at a time (or even one day’s worth).
4. The prescribing clinician can also decide to prescribe one week worth of medication at a time, with refills. While it is a nuisance for the patient to have to go to the pharmacy every week and have to pay a co-pay every time, in difficult situations it is the right thing to do unless a responsible person can keep the medication.
5. Similarly, large knives should be removed from the house. The person can manage cooking with small knives.
Suicide prevention plan
I am increasingly convinced that having a suicide prevention plan is key. That is, what would the person do if he or she felt more suicidal? A hotline, family member or friend, and a clinician should all be identified.
1. The number for the Suicide & Crisis Lifeline is 988 and this number should be given to all persons who have suicidal ideation. The calls get routed to local mental health professionals based on where the patient is.
2. The person should be asked to pick two particular family members or friends whom s/he could call if s/he felt worse and needed more emotional support. Of course, the idea is not that the family member or friend would prevent the suicide, only help the person to feel emotionally better. If the suicidal ideation is strong, the patient should ask the family member to call 911 or bring the patient to the ER for evaluation.
3. I even decide with the patient which hospital the patient would go to if he and his support person decide to go to the emergency room themselves rather than call 911.
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