Oregon law calls for suicide risk screening before discharge, but will it be enough?

A new Oregon law calls for a mandatory screening process in emergency departments for patients who are in mental health crisis. The law prohibits discharging patients without first screening them for suicidal thinking, ensuring their capacity for self-care and scheduling their follow-up appointments. This law comes at a very important time for Oregon hospitals. Portland hospitals have seen a record volume of psychiatric patients, especially in pediatric emergency departments. Many attribute this to the "13 Reasons Why Effect", since it’s Netflix release in March 2017. Oregon typically has 6-7 deaths by suicide per month. In March, 18 Oregon teenagers took their lives. According to the data, suicide ranks as the number one killer for people ages 15-44.

Prior to the law being passed, hospital administrators had argued with legislative officials that nurses and doctors are not equipped to counsel the mentally ill on top of stressful shifts in the emergency room.

We can’t expect our doctors and nurses to have this type of specialty training or space in their shift to handle these time-intensive cases. Instead we should ask them to consult with licensed mental health professionals stationed in the emergency room just as they would any other medical specialty. Well-established emergency departments at Legacy Emanuel and OHSU have been outsourcing this role for years to licensed clinical social workers (LCSW) who are key players in these high stakes cases.

Clinical social workers are trained to conduct psychiatric interviews in a meaningful way. These interviews are delicate and take focus. They take connection and empathy. They go beyond the typical protocol of asking “Do you want to kill yourself?” and “Do you have a plan?”

Research suggests that patients with the most serious suicidal intent may be the most likely to withhold it. The true art of psychiatric interviewing can be lifesaving when those who are dangerously suicidal finally feel a small bit of hope after connecting with the therapist at their bedside. Enough hope to share the unsayable truth. This therapeutic skill is literally what saves lives.

If emergency departments really want to change these haunting statistics, the screening law is a great start -- but hospital administrators should strongly consider going above the minimum standard by including mental health specialists in every emergency room. They play an invaluable consultation role to the medical team and will reduce deadly errors.