Effective immediately, The Joint Commission will place added emphasis on the assessment of ligature, suicide and self-harm observations in psychiatric hospitals and inpatient psychiatric patient areas in general hospitals. This comes at a time when there is national concern about the number of suicides in hospitals. Also, the “Zero Suicide” campaign has set a new bar to eliminate suicides in health care facilities. Suicide is among the Top 5 sentinel events in The Joint Commission’s database.
Research has shown that many suicide attempts are impulsive. There is little disagreement that a facility that can eliminate environmental risks is reducing the means and opportunities for patients to commit suicide and/or harm themselves.
Inpatient Suicide and Self-Harm
While discussing such topics can be disturbing to some, it’s important to face the facts. According to an article in 2008, the National Institutes of Health reported an estimated 1,800 inpatient suicides per year, but pointed to a gap in data gathering:
Little is known about suicide in the hospital setting. Although suicide is a major public health concern, the literature on suicide in the medical setting is limited, and accurate data on hospital-based suicides are unavailable. This likely is the reason The Joint Commission is now seeking to shine a bright light on self-harm.
A 2012 presentation by Peter Mills, Ph.D., addressed inpatient suicides in VA hospitals. Some key facts Dr. Mills shared were:
- Inpatient suicide rates estimated to be 5-80 per 100,000 psychiatric admissions in U.S.
- Physical environment a root cause in 84% of Joint Commission (JC) sentinel event inpatient suicides.
- Hanging is the most common method reported in JC (75%) literature and in the VA (30.4%).
- 50% of suicides by hanging were NOT fully suspended – using anchor points below the head.
In the following chart by Dr. Mills, it is also significant to note that cutting ranks second overall and in the number of attempts made:
Safer by design
The ripple effect to the architecture, engineering, and construction community will be an increased emphasis on self-harm risk mitigation, which will include design elements that curtail the opportunity for patients to harm themselves.
It’s important to stress that no design or product should claim to be “suicide proof.” However, every possible avenue should be explored and developed to reduce risk.
Another impact is that the increased Joint Commission scrutiny includes evaluating existing plans the facility has for removing self-harm risks. This has the potential to mean the need for redesign and remodeling of facilities, and retrofit of ligature resistant fixtures, etc.
Continuing Education Seminar addresses Behavioral Health Design for Architects and Designers
Inpro has created a new AIA/IDCEC Continuing Education program entitled: Design Considerations for Behavioral Health, which helps attendees:
- Discover the expanding definition of mental health, the market forces at play, and the shortfalls in inpatient capacity.
- Explain the types and incidence of self-harm in healthcare settings, and how such knowledge can lead to safer design.
- Describe risk assessment strategies for the behavioral health built space.
- Identify products designed to reduce the risk of self-harm.
If your firm is interested in learning more about behavioral health design, schedule a FREE CEU session today.