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.
