Making the Case for Suicide Risk Screening in Outpatient Podiatry Patients: An Opportunity for Injury Prevention

Background: Despite prevention efforts, suicide rates continue to rise, prompting the need for novel evidence-based approaches to suicide prevention. Patients presenting with foot and ankle disorders in a podiatric medical and surgical practice may represent a population at risk for suicide, given risk factors of chronic pain and debilitating injury. Screening has the potential to identify people at risk that may otherwise go unrecognized. This quality improvement project (QIP) aimed to determine the feasibility of implementing suicide risk screening in an outpatient podiatry clinic and ambulatory surgical center. Methods: A suicide risk screening QIP was implemented in an outpatient podiatry clinic and ambulatory surgical center in collaboration with a National Institute of Mental Health (NIMH) suicide prevention research team. Following training for all staff, patients ages 18 years and older were screened for suicide risk with the Ask Suicide-Screening Questions (ASQ) as standard of care. Clinic staff were surveyed about their opinions of screening. Results: Ninety-four percent of patients (442/470) agreed to be screened for suicide risk and nine patients (2%; 9/442) screened non-acute positive; zero for acute risk. The majority of clinic staff reported that they found screening acceptable, felt comfortable working with patients who have suicidal thoughts, and thought screening for suicide risk was clinically useful. Conclusions: Suicide risk screening was successfully implemented in an outpatient podiatry clinic. Screening with the ASQ provided valuable information that would not have been ascertained otherwise, positively impacting clinical decision-making and leading to improved overall care for podiatry patients.

Balance Beams and Suicide-Risk Screening

This chapter examines how the mental illness model of suicide has led us to place more faith than may be warranted in concepts such as suicide “warning signs” and suicide-risk screening tools. These concepts are notoriously unreliable indicators of emerging suicidal behaviors because they do not sufficiently reflect the inherently dynamic and ever-changing nature of suicide risk. Any given warning sign for suicide will be wrong much, much more often than it will be right. Even when multiple warning signs are experienced or expressed by an individual, this problem persists. One factor limiting the accuracy of suicide-risk screening is that thoughts about death and suicide fluctuate over time. Thus, we should move away from assuming that we must know who will and who will not attempt suicide to prevent these behaviors from occurring.