Lethal Means Assessment in Psychiatric Emergency Services: Frequency and Characteristics of Assessment

Lethal means safety is an effective suicide prevention strategy with demonstrated results at the population and policy level, yet uptake at the individual-level is less well understood. Using automated data extraction methods, we conducted an investigation of psychiatric emergency service (PES) patients from 1/1/12 through 12/31/17 at one of the busiest emergency departments in the Pacific Northwest. Every patient received a Suicide Risk Assessment during which providers used an electronic template with standardized fields to record access to lethal means and other suicide risk factors. We assessed 32,658 PES visit records belonging to 15,652 patients. Among all patient visits, 69.9% (n=22,824) had some documentation of lethal means assessment. However, over one-half of all visits lacked some or all documentation. Despite the high-risk patient population, mental health specific focus of the facility, and presence of a standardized tool, lethal means documentation was suboptimal. In alignment with recent recommendations, our findings suggest that additional operational interventions may be required to improve lethal means assessment documentation frequency and detail to cultivate a more robust suicide prevention infrastructure.