Incorporate
a Health Insurance Portability and Accountability Act (HIPAA)
compliant telehealth dimension into your practice, as this can
significantly extend your diagnostic and therapeutic reach.
There are several video platforms readily available for this purpose, such as Zoom, Updox, Webex, Doxy. me, etc.
HHS Telehealth resources for behavioral health care, direct-to-consumer health care, and emergency departments.
Familiarize
yourself with your specialty's information regarding telehealth
practice guidelines and patient-provider identification.
Use consent forms specially designed for telehealth consultations:
It is best to observe basic guidelines when working with a potentially suicidal patient:
Request
the person's location (address, apartment number) at the start of
any session in case you need to contact emergency services.
Request or make sure you have emergency contact information.
Secure the patient's privacy during the telehealth session as much as possible.
Inquire about increased access to potentially lethal means.
Clinical management issues:
Identify a method of increasing safety as part of your response repertoire, e.g., a safety plan.
Provide crisis hotline (988).
Identify
individuals in the patient's current environment to help monitor
suicidal thoughts and behaviors in-person or remotely; seek
permission to have direct contact with those individuals.
If
the risk becomes imminent and cannot be managed remotely, arrange
for the client to go to the nearest crisis center or medical ED.
If the risk is imminent, stay on the phone with the patient until other care is present.
Safety planning
If
the patient is found not to need emergent management, creating a
safety plan with the patient is a way to stay safe without using
more emergent settings.
Arrange a
way for the patient to get a copy of their plan (e.g., take a
picture or scan, and e-mail or text to the patient).
If
possible, leverage the client's natural supports to assist them
during care transitions. They might need someone to stay with them
for a while.
Ask your client about their Safety Plan; go over it with them and collaboratively make any adjustments to the plan if needed.
Process
the experience with your client of going to the emergency
department or inpatient setting, etc. These events can be
traumatizing, and your client will benefit from processing them.
Use an evidenced-based treatment upon discharge that is targeted to suicidality (CAMS, DBT).
Suggest the SPRC website; search for care transitions.
Ask about their household firearm storage practices and make recommendations to increase the safe storage of firearms.
Ask
if all firearms can be or are safely stored (e.g., with a locking
device such as cable locks, or trigger locks) or use locking
containers (e.g., lockboxes, firearm safes, firearm cabinets).
Engage household members to support safe storage.
Normalize
gun ownership, speak with someone else in the home, move away from
the computer when talking- trust is essential, and stress the
importance of respecting their right to own a gun.