Partner with Healthcare Providers

No one person or organization can prevent suicide alone, and suicide prevention requires a coordinated response: suicide prevention-related organizations, like crisis lines and crisis programs, need to partner with healthcare organizations¹. Many individuals who die by suicide had recent healthcare visits, highlighting the critical role healthcare systems can play in suicide prevention through screening, safety planning, referrals, and follow-up care/communication^2,3,4. Healthcare providers can update their voicemails or automated answering systems to refer people to crisis lines if they are experiencing a behavioral health or emotional crisis, in addition to displaying promotional materials in reception areas and waiting rooms⁵. Healthcare providers are trusted messengers and can engage in lethal means counseling, which is crucial for preventing suicide^6,7. However, barriers such as misconceptions and lack of training hinder effective counseling among healthcare providers resources^8,9.

Emergency departments (ED), trauma centers, and Emergency Medical Service (EMS) providers also play a vital role in suicide prevention. Research shows a significant gap in services for suicide attempt survivors post-discharge, with the highest risk of suicide occurring within the first week after discharge from an inpatient hospital setting¹⁰. Follow-up communication provided by crisis lines and centers has been shown to reduce suicide risk and provide essential emotional support. Developing written discharge protocols among EMS teams that include referrals to crisis lines can ensure continuous care and support for individuals at elevated risk, helping to bridge the gap between emergency care and ongoing mental health support^11,12. Service providers, including hospital social workers, doctors, and nurses, can briefly promote crisis lines after a crisis is stabilized⁵. Emergency departments can engage with crisis lines to build relationships and consider contracting or creating written agreements with the local crisis line provider for follow-up calls to ensure the patient speaks with someone trained in mental health and suicide care between discharge and outpatient appointments¹¹. Crisis lines and centers can provide knowledge on suicide safety assessment, training, and consultation to ED staff¹⁰. If the relationships are not yet built, crisis lines can survey hospitals to assess their attitudes about partnering with crisis lines as the relationships will take time to build¹⁰.

Besides emergency settings, primary care physicians can use firearm-friendly language with patients to foster trust and open communication about safe firearm storage practices¹³. Advanced practice psychiatric nurses play a crucial role in advocating for patients and reducing firearm violence through awareness and education about resources like crisis lines¹⁴. They engage with individuals from diverse backgrounds facing crises and can prioritize educating their patients about the crisis lines, which offer support, safety planning, and follow-up¹⁴.

1. National Alliance for Suicide Prevention. (2020). Lethal Means & Suicide Prevention: A Guide for Community & Industry Leaders. Retrieved from https://theactionalliance.org/resource/lethal-means-suicide-prevention-guide-community-industry-leaders
2. Ahmedani, B. K., Simon, G. E., Stewart, C., Beck, A., Waitzfelder, B. E., Rossom, R., Lynch, F., Owen-Smith, A., Hunkeler, E. M., Whiteside, U., Operskalski, B. H., Coffey, M. J., & Solberg, L. I. (2014). Health care contacts in the year before suicide death. Journal of General Internal Medicine, 29(6), 870–877. https://doi.org/10.1007/s11606-014-2767-3
3. Stene-Larsen K., &  Reneflot A. (2017). Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017. Scandinavian Journal of Public Health. 2017;47(1):9-17. http://doi:10.1177/1403494817746274
4. National Action Alliance for Suicide Prevention. (2018). Recommended Standard of Care for People with Suicide Risk: Making Health Care Suicide Safe. Retrieved from https://theactionalliance.org/sites/default/files/action_alliance_recommended_standard_care_final.pdf
5. Substance Abuse and Mental Health Services Administration [SAMHSA]. (2024) Advising People on Using 988 Versus 911: Practical Approaches for Healthcare Providers. Retrieved from https://library.samhsa.gov/product/advising-people-using-988-versus-911-practical-approaches-healthcare-providers/pep24-06-009
6. Allchin, A., Chaplin, V., & Horwitz, J. (2019). Limiting access to lethal means: Applying the social ecological model for firearm suicide prevention. Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention, 25(Suppl 1), i44–i48. https://doi.org/10.1136/injuryprev-2018-042809
7. Suicide Prevention Resource Center. (2024). Public Perceptions of Mental Health and Suicide Prevention Survey Results. Retrieved from https://suicidepreventionnow.org/documents/executive-summary-2024.pdf
8. Allchin A., & Chaplin V. (2017). Breaking Through Barriers: The Emerging Role of Healthcare Provider Training Programs in Firearm Suicide Prevention. Washington, D.C. https://efsgv.org/wp-content/uploads/2017/09/Breaking-through-Barriers-September-2017-Consortium-for-Risk-Based-Firearm-Policy-FINAL.pdf
9. Kemal, S., Lennon, T., Simon, N. J., Kaczor, K., Hilliard, M., Corboy, J. B., & Hoffmann, J. A. (2024). Improving documentation of firearm access during pediatric emergency visits for suicidal ideation. Pediatrics. Pediatrics, 153(4), e2023063447. https://doi.org/10.1542/peds.2023-063447
10. Substance Abuse and Mental Health Services Administration [SAMHSA]. (2023). Crisis Center Guidance: Follow-up with 988 Lifeline Contacts and Those Discharged from Emergency Department and Inpatient Settings. Retrieved from https://988lifeline.org/wp-content/uploads/2023/07/May-2023-Follow-up-Guidance-Doc.pdf
11. National Action Alliance for Suicide Prevention. (2024). Emergency Department Best Practices: Care Transitions for Individuals with Suicide Risk. Retrieved from https://theactionalliance.org/sites/default/files/aa-edbest_practices-2024-final_0.pdf
12. Runyan, C. W., Brooks-Russell, A., Tung, G., Brandspigel, S., Betz, M. E., Novins, D. K., & Agans, R. (2018). Hospital emergency department lethal means counseling for suicidal patients. American Journal of Preventive Medicine, 54(2), 259–265. https://doi.org/10.1016/j.amepre.2017.10.023
13. Anestis, M. D., Bryan, C. J., Capron, D. W., & Bryan, A. O. (2022). Evaluation of safe firearm storage messaging in a sample of Firearm-owning US military service members. JAMA Network Open, 5(10), e2235984. https://doi.org/10.1001/jamanetworkopen.2022.35984
14. Glodstein S. L. (2023). The lifeline and advanced practice nursing/intervention prevention perspective. Archives of Psychiatric Nursing, 47, 47–49. https://doi.org/10.1016/j.apnu.2023.10.008

Although these examples highlight the connection between the 988 Suicide and Crisis Lifeline and healthcare, other crisis programs can use these examples and resources to partner as well. 

• In Colorado, after someone is discharged from the ED after experiencing suicidal ideation, self-harm, or other mental health or substance use crisis, the providers from 71 ED partners across Colorado work with their state crisis hotline provider and hub for the 988 Suicide and Crisis Lifeline. This partnership ensures that patients are connected with experienced follow-up specialists who are trained in safety assessment, harm reduction, local resource linkage, and goal service, available 24/7. Findings indicate that the follow-up efforts reduce service barriers and increase post-discharge connections to resources¹¹. 

• There are some partnerships between crisis centers and emergency departments. Follow-up Matters includes information about current follow-up partnerships, including information as they develop their processes and partnerships over time.  

• SAMHSA’s guide on Advising People on Using 988 Versus 911: Practical Approaches for Healthcare Providers provides support for healthcare providers to help people to understand when to use the 988 Suicide and Crisis Lifeline for behavioral health support and 911 for physical emergencies. It offers clear explanations, real-world scenarios, and addresses common concerns.  
  • Key takeaways: 

• • • Primary Care: During routing visits, educate people about using the 988 Suicide and Crisis Lifeline for behavioral health support and 911 for physical emergencies. 

• • • Behavioral Health: Role play crisis scenarios as a part of safety planning to simulate when and how to use the 988 Suicide and Crisis Lifeline versus 911. 

• • • Emergency Medical Services (EMS): After crisis intervention, educate people and their trusted network about future use of the 988 Suicide and Crisis Lifeline for nonemergency behavioral health needs. 

• • • After stabilizing a crisis situation, healthcare providers should evaluate the person’s need for follow-up behavioral health support and provide information about the 988 Suicide and Crisis Lifeline. 

• • • Healthcare providers should address fears and concerns about using the 988 Suicide and Crisis Lifeline, ensuring people feel confident and understand what will happen when they call. The 988 Lifeline website offers resources for what to expect when contacting 988. 

• In this resource, SAMHSA includes a 988 Suicide and Crisis Lifeline/Emergency Department partnership model which includes centers providing 988 marketing materials to EDs, discharge planners and facilities discussing the use of the crisis center services with patients before discharge and handing materials to the patient, and 988 Suicide and Crisis Lifeline center staff providing assessment training and consultation to ED staff, for example. 

• On the Follow-Up Matters webpage, you can find examples of formal agreements between 988 Suicide and Crisis Lifeline contact centers and emergency departments, inpatient psychiatric facilities, and primary care physicians. 

• In the 2024 Emergency Department Best Practices: Care Transitions for Individuals with Suicide Risk Guide, you can find recommendations for emergency departments including developing formal policies for mental health outpatient provider referrals; discharge planning and collaborative care; recommendations for collaborating with the community; and recommendations for engaging existing infrastructure such as 988 Suicide and Crisis Lifeline centers. 

• Healthcare providers in primary care, behavioral health, and EMS settings can use materials from the 988 Suicide and Crisis Lifeline Partner Toolkit to promote awareness and initiate conversations with people about behavioral health crises. Free resources suitable for use in healthcare settings are available to order or print.