Suicide is a public health issue in Colorado. This project addresses a critical need in our systems of care: follow up services.
Colorado’s Hospital Follow-Up Project is a collaboration between CDPHE’s Office of Suicide Prevention, Rocky Mountain Crisis Partners, Second Wind Fund and health systems across the state. Supported by grant funding from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) the Follow Up Project seeks to provide telephonic caring contacts to clients discharging from an emergency department. Patients are eligible to participate after experiencing a mental health crisis, suicidal ideation, behavior, and attempt, self-harm, substance use, opioid use, or overdose event, regardless of intent. These services come at no-cost to enrolled sites and patients across Colorado.
What are Follow Up services?
Follow up services are telephonic caring contacts offered to clients discharging from an emergency department after experiencing a mental health crisis or overdose event. These contacts typically occur weekly for 30 days, a high risk time period post-discharge.
Why Follow Up services?
Individuals are at an increased risk for suicide and suicide attempt:
- The risk of a suicide attempt or death is highest within 30 days of discharge from an ED or inpatient psychiatric unit.2
- Between 2008 and 2017, the rate of emergency department (ED) visits related to suicidal ideation or suicide attempt increased for all age groups.1
- In 2017, 64.4 percent of ED visits related to suicidal ideation or suicide attempt resulted in an admission to the hospital or transfer to another facility versus 17.1 percent for all other ED visits.1
- Up to 70% of patients who leave the ED after a suicide attempt never attend their first outpatient appointment.2
- In the month after patients leave inpatient psychiatric care, their suicide death rate is can be up to 300 times higher than the general population’s. Their suicide risk remains high for up to three months after discharge and for some, their elevated risk endures after discharge.5
Research indicates that follow-up services for individuals recently discharged from the ED has positive results for both consumers and providers of mental health services.3 Telephonic follow-up has been shown to improve client outcomes, reduce the likelihood of reattempt, and increase the connection with helping resources post-discharge. Follow-up protocols have also been shown to reduce the need for future hospitalizations by reducing barriers to accessing services in a timelier manner. Additionally, follow-up care has been shown to be cost-effective and prevent suicides.
The Follow Up Project is a key element in the continuum of care for clients experiencing suicidality.4
Read through the results of the pilot program of the Follow Up project from July 1, 2015 to October 31, 2017: Implementing an Emergency Department Telephone Follow-Up Program for Suicidal Patients: Successes and Challenges.4
1. Statistical Brief #263. Healthcare Cost and Utilization Project (HCUP). September 2020. Agency for Healthcare Research and Quality, Rockville, MD.
2. Knesper, D. J. (2010). Continuity of care for suicide prevention and research: Suicide attempts and suicide deaths subsequent to discharge from the emergency department or psychiatry inpatient unit. Newton, MA: Suicide Prevention Resource Center.
3. National Action Alliance for Suicide Prevention: Transforming Health Systems Initiative Work Group.(2018). Recommended standard care for people with suicide risk: Making health care suicide safe. Washington, DC: Education Development Center, Inc
4. The Joint Commission Journal on Quality and Patient Safety 2019; 45:725–732
5. (2019). Best Practices in Care Transitions for Individuals with Suicide Risk: INPATIENT CARE TO OUTPATIENT CARE. National Action Alliance for Suicide Prevention.
How it Works
The Follow-Up Project model involves hospital staff screening people who are preparing to leave an inpatient or emergency department for suicide risk, referring them to and encouraging them to participate in the program, and conducting a “warm handoff” to hotline clinicians over the phone. Once hotline staff have an individual’s consent and contact information, they will reach out to them multiple times within the first 24 to 48 hours after discharge, and then on a regular basis (typically weekly) for a month or longer as needed.
Follow Up Specialists offer support through safety assessment, harm reduction, resource linkage and collaborative goal setting. Services are caring, non-demand, and accessible 24/7/365.
Who provides follow up?
Rocky Mountain Crisis Partners comes equipped with multiple kinds of follow up specialists, ensuring that your clients are placed into trained, caring hands. Follow Up Specialists have varying areas of expertise, such as clinical based support, peer based support, clinical opiate specific support, and veteran peer support.
All specialists have graduated with a Bachelors or Masters. In addition, they complete 4 weeks of crisis training targeting suicidal ideation, self-harm, and substance use. Specialists also undergo ongoing training throughout their tenure at Rocky Mountain Crisis Partners.
Facility eligibility: All Colorado Emergency Departments are eligible to participate!
Client eligibility: The Follow-Up Project was initially designed to serve clients experiencing suicidality. However, with additional funding, client eligibility has been increased to include anyone struggling with:
Suicidal behavior or attempts
Overdoses, regardless of intent