Nirvana Recovery

Guide for Suicide Risk Inpatient to Outpatient Care Transitions in Arizona

Arizona Deaths by Suicide 2010-2022

Suicide is a heartbreaking reality and a serious public health issue in Arizona. From 2010 to 2022, the graph for suicide has been constantly increasing. Ensuring continuity of care during the transition from inpatient to outpatient behavioral health services is crucial for preventing tragedy among this vulnerable population. This comprehensive guide provides evidence-based recommendations and Arizona-specific context to help inpatient and outpatient providers work together to close gaps in care transitions and save lives.

The Importance of Care Transitions in Suicide Prevention

Suicide Risk After Psychiatric Hospitalization

  • The transition from inpatient psychiatric care to outpatient treatment is a critical period for patients at risk of suicide. A 2019 meta-analysis found that in the first week after discharge, patients’ suicide rate was 300 times higher than the general population’s. The suicide rate remains 200 times higher in the first month and stays elevated for three months or more after leaving inpatient care.
  • In the U.S., 14.2% of people who died by suicide had contact with inpatient mental health services in the year prior to their death (Ahmedani et al., 2014). Clearly, the transition from the controlled inpatient environment to the challenges of daily life at home is a particularly high-risk time that requires intensive support.

Gaps in Arizona's Behavioral Health System

Arizona Ranked 49
  • 20.78% of adults experienced a mental illness. Equivalent to over 50 million Americans, says Mental Health America.
  • A 2023 profile by SAMHSA ranked Arizona 49 for overall adult mental health. Only 36.5% of Arizona adults with any mental illness received treatment in 2023 and the remaining 63.5% people didn’t got any treatment.
States with the highest rate of untreated mental illness
  • According to Forbes Arziona finds itself plummeting towards the bottom of the list, placing 7th among worst states for access to mental health care.
The Worst States For Mental Health Care

After psychiatric hospitalization, almost a third (27.7%) of Arizona patients did not have an outpatient visit within 30 days of discharge.

These system gaps place patients at risk during the transition from inpatient to outpatient care. Implementing best practices in care transitions, as outlined in this guide, can help Arizona providers deliver more seamless and supportive services during this critical time.

Best Practice Recommendations

The following evidence-based strategies, drawn from the 2019 report “Best Practices in Care Transitions for Individuals with Suicide Risk,” provide a roadmap for Arizona inpatient and outpatient organizations to improve care transitions:

Develop Collaborative Partnerships

  • Establish formal agreements (MOUs/MOAs) between inpatient and outpatient providers that specify shared protocols for rapid referrals, exchange of essential records, and coordination of care, especially for suicidal patients.
  • Meet regularly to review implementation of protocols, troubleshoot barriers, and build partnership.
  • Provide training for all staff in best practices for compassionately serving patients at risk of suicide.

Schedule Rapid Referrals Inpatient Providers

  • Collaboratively develop a safety plan and secure an outpatient appointment within 24-72 hours of discharge.
  • Electronically send crucial records (safety plan, discharge plan, medication list, etc.) to outpatient provider same-day.

Outpatient Providers

  • Offer prioritized intake appointments for patients recently discharged from inpatient care.
  • Provide same-day evaluation for patients who miss their initial post-discharge appointment.

Engage Family and Support Systems

  • Involve family and natural support in safety planning, discharge planning, and identifying potential home environment risks.
  • Provide resources and referrals to support family members, such as NAMI Arizona’s Family-to-Family program.
  • Coordinate with school personnel to ensure proper support is in place for youth.

Provide Caring Contacts

  • Inpatient staff should follow up with the patient via phone within 24 hours of discharge and until their first outpatient appointment.
  • Send caring contacts (brief messages of support via text, email, or mail) regularly for at least 12 months post-discharge.

Consider Step-Down and Peer Support Services

  • Utilize a range of step-down care options (partial hospitalization, intensive outpatient, etc.) based on the patient’s needs.
  • Engage peer support specialists to provide hope, practical assistance, and social connection.

Implementing Best Practices in Arizona

Putting It All Together Inpatient and outpatient teams must recognize their shared responsibility for patient safety during care transitions. Working in close partnership, with comprehensive communication and rapid referral protocols, is essential.

Arizona providers can concretely improve care transitions for suicidal patients by:

  1. Formalizing collaborative partnerships.
  2. Scheduling outpatient appointments before discharge.
  3. Transmitting essential records electronically.
  4. Involving family/support systems in transition planning.
  5. Conducting post-discharge outreach and caring contacts.

Measuring Progress To evaluate the impact of care transition improvement efforts, organizations can track metrics such as:

  • Percentage of patients attending outpatient appointments within 72 hours.
  • Percentage of patients receiving follow-up contact within 24 hours.
  • Suicide attempts and deaths within 3 months of discharge.

Conclusion

The deadly risks of failed inpatient-to-outpatient transitions demand urgent action from Arizona’s behavioral health community. By implementing the evidence-based practices outlined here, we can provide suicidal patients with a more supported, continuous path to recovery.

In a system that often lets the most vulnerable fall through the cracks, closing care transition gaps is both an ethical necessity and a life-saving intervention. Arizona providers must work together to ensure patients have the ongoing care and compassion they need during high-stakes transition. Our community will be healthier and stronger as a result.

Furthermore, if you want to delve deeper into the details, check out the PDF we’ve attached below. It’s got all the details you need so that you won’t miss a thing. 

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Nirvana Recovery