Original Article | June 2012
Examination of the Effectiveness of the Mental Health Environment of Care Checklist in Reducing Suicide on Inpatient Mental Health Units
Bradley V. Watts, MD, MPH; Yinong Young-Xu, ScD, MA, MS; Peter D. Mills,
Context Suicide is one of the leading causes of death in the United States. While suicides occurring during psychiatric hospitalization represent a very small proportion of the total number of suicides, these events are highly preventable owing to the controlled nature of the environment. Many methods have been proposed, but no interventions have been tested.
Objective To evaluate the effect of identification and abatement of hazards on inpatient suicides in the Veterans Health Administration (VHA).
Design, Setting, and Patients The effect of implementation of a checklist (the Mental Health Environment of Care Checklist) and abatement process designed to remove suicide hazards from inpatient mental health units in all VHA hospitals was examined by measuring change in the rate of suicides before and after the intervention.
Intervention Implementation of the Mental Health Environment of Care Checklist.
Main Outcome Measure The number of completed suicides on inpatient mental health units in VHA hospitals.
Results Implementation of the Mental Health Environment of Care Checklist was associated with a reduction in the rate of completed inpatient suicide in VHA hospitals nationally. This reduction remained present when controlling for number of admissions (2.64 per 100 000 admissions before to 0.87 per 100 000 admissions after implementation; P < .001) and bed days of care (2.08 per 1 million bed days before to 0.79 per 1 million bed days after implementation; P < .001).
Conclusions Use of the Mental Health Environment of Care Checklist was associated with a substantial reduction in the inpatient suicide rate occurring on VHA mental health units. Use of the checklist in non-VHA hospitals may be warranted.
PhD, MS; Joseph M. DeRosier, PE, CSP; Jan Kemp, RN, PhD; Brian Shiner, MD, MPH; William E. Duncan, MD, PhD
[-] Author Affiliations
Author Affiliations: VA National Center for Patient Safety, White River Junction, Vermont, and Ann Arbor, Michigan (Drs Watts, Young-Xu, and Mills and Mr DeRosier); Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire (Drs Watts, Young-Xu, Mills, and Shiner); VA Office of Mental Health Services, Suicide Prevention, Canandagua, New York (Dr Kemp); Veterans Engineering Resource Center, White River Junction, Vermont (Dr Shiner); and VA Office of Quality and Safety, Washington, DC (Dr Duncan).
Arch Gen Psychiatry. 2012;69(6):588-592. doi:10.1001/archgenpsychiatry.2011.1514