The Follow-Up Project

What are Follow-Up services?

Follow-up services are telephonic caring contacts offered to clients discharged 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 attempts:

• 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 attempts increased for all age groups.¹
• In 2017, 64.4 percent of ED visits related to suicidal ideation or suicide attempts 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 have 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

References
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.