What type of facility do patients with suicidal ideation go to for immediate evaluation and treatment?

Facilities for Patients with Suicidal Ideation

Patients with suicidal ideation should be triaged to appropriate facilities based on risk assessment, with high-risk patients requiring inpatient psychiatric hospitalization, moderate-risk patients benefiting from partial hospitalization programs, and lower-risk patients with adequate support systems receiving outpatient mental health treatment. 1, 2

Risk Assessment to Determine Appropriate Facility

Risk assessment should guide facility selection based on:

High Risk Indicators (Requiring Inpatient Psychiatric Hospitalization)

• Continued endorsement of desire to die
• Severe agitation or hopelessness
• Inability to engage in safety planning
• Inadequate support system
• High-lethality suicide attempt or clear expectation of death
• Previous suicide attempts
• Evidence of serious psychiatric illness
• Active substance use disorder
• Low impulse control
• Families unwilling to commit to counseling 1

Moderate Risk Indicators (Suitable for Partial Hospitalization)

• Disturbed but containable in supportive home setting
• Need for intensive multidisciplinary treatment
• Step-down from acute psychiatric hospitalization 1

Lower Risk Indicators (Appropriate for Outpatient Treatment)

• Responsive and supportive family
• Low likelihood of acting on suicidal impulses
• No specific intent or plan
• Someone available to monitor and take action if condition deteriorates 1

Types of Facilities for Suicidal Patients

1. Emergency Department (ED)

• Initial evaluation point for acute suicidal crises
• Provides triage function and medical stabilization
• Should include safety planning discussions before discharge
• May implement Family-Based Crisis Intervention (FBCI) to stabilize patients within a single ED visit 1, 3
• Some EDs have specialized Emergency Psychiatric Assessment, Treatment, and Healing (EmPATH) units that can decrease hospital admission rates and improve follow-up care 4

2. Inpatient Psychiatric Facilities

• Provides safe, protected environment for high-risk patients
• Allows for complete medical and psychiatric evaluation
• Enables initiation of therapy in controlled setting
• Facilitates arrangement of appropriate mental health follow-up care 1
• Exposure to other suicidal patients does not increase risk 1

3. Partial Hospitalization Programs

• Intensive multidisciplinary treatment without overnight stay
• Alternative to acute psychiatric hospitalization for moderate-risk patients
• Provides more time than acute hospitalization to stabilize emotional condition
• Addresses environmental stressors and problems
• Can serve as step-down from acute psychiatric hospitalization 1

4. Intensive Outpatient Services

• For patients who don't meet criteria for inpatient hospitalization
• Provides more intensive treatment than standard outpatient care
• Appropriate for patients who would benefit from urgent treatment 1

5. In-Home Treatment/Crisis Stabilization Programs

• Alternative to hospitalization for some patients
• Provides intensive services in the patient's home environment
• Can help stabilize crisis situations while maintaining patient in familiar surroundings 1

Discharge Planning and Follow-Up

Regardless of facility type, discharge planning should include:

• Safety planning discussion (not no-suicide contracts, which are ineffective)
• Means restriction counseling (securing/removing firearms, locking medications)
• Identification of warning signs and triggers
• Development of coping strategies
• Identification of social supports and professional contacts
• Clear follow-up appointment scheduling
• Family education about suicide risk and treatment 1, 2

Common Pitfalls to Avoid

• Underestimating risk (70% of individuals who died by suicide had been assessed by mental health professionals) 2
• Overreliance on no-suicide contracts instead of vigilant monitoring 2
• Inadequate follow-up planning 2
• Failing to secure means of suicide (especially firearms and medications) 1
• Discharging patients without verifying their account with caregivers 1

Evidence for Alternative Approaches

Recent research shows promise for alternatives to traditional hospitalization:

• Family-Based Crisis Intervention (FBCI) in the ED can safely reduce the need for inpatient hospitalization (36% vs 55% hospitalization rate) 5, 3
• EmPATH units in EDs have been shown to reduce psychiatric admissions by 52% while increasing 30-day follow-up care by 60% 4
• Evidence-based psychological interventions for suicide risk are emerging as alternatives to hospitalization and medication alone 6

The appropriate facility for a suicidal patient should be determined by comprehensive risk assessment, with patient safety as the paramount concern. While hospitalization remains the safest option for high-risk patients, newer models of care are showing promise for safely treating moderate-risk patients in less restrictive settings.