After an Attempt

A Guide for Medical Providers 

in the Emergency Department 

Taking Care of Suicide Attempt 

Survivors

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

www.samhsa.gov
If you are in crisis, please call:

National Suicide Prevention Lifeline

1-800-273-TALK (8255). 

Veterans, press 1.

http://www.suicidepreventionlifeline.org
National Suicide Prevention Lifeline: 

After an Attempt

A Guide for Medical Providers in the 

Emergency Department Taking Care of 

Suicide Attempt Survivors
Acknowledgements

This brochure was originally developed by the National 

Alliance on Mental Illness (http://www.nami.org) in 

partnership with the Suicide Prevention Resource Center 

(http://www.sprc.org) under Grant Number 1.U79 

SM55029-01 from the Substance Abuse and Mental 

Health Services Administration (SAMHSA), U. S. 

Department of Health and Human Services (HHS). 

Disclaimer

The views, opinions, and content of this publication are 

those of the authors and contributors and do not necessarily 

reflect the views, opinions, or policies of the Center for 

Mental Health Services (CMHS), SAMHSA, or HHS.

Public Domain Notice

All material appearing in this publication is in the public 

domain and may be reproduced or copied without 

permission from SAMHSA. Citation of the source is 

appreciated. This publication may not be reproduced 

or distributed for a fee without the specific, written 

authorization of the Office of Communications, SAMHSA, 

HHS. 

Recommended Citation 

Substance Abuse and Mental Health Services 

Administration. After an Attempt: A Guide for Medical 

Providers in the Emergency Department Taking Care of 

Suicide Attempt Survivors. DHHS Pub. No. (SMA) 

08-4359, Rockville, MD: Center for Mental Health 

Services, Substance Abuse and Mental Health Services 

Administration, U.S. Department of Health and Human 

Services, 2006. Reprinted by the Department of Veterans 

Affairs, Veterans Health Administration, 2008. 

For Copies of This Publication

• Download copies from the National Suicide Prevention 

Lifeline Website: http://www.suicidepreventionlifeline.

org/veterans/

• This publication may be downloaded or ordered at 

http://www.samhsa.gov/shin. Or, please call SAMHSA’s 

Health Information Network at 1-877-SAMHSA-7 (1-

877-726-4727) (English and Español).

Originating Office

Center for Mental Health Services

Substance Abuse and Mental Health Services 

Administration

1 Choke Cherry Road

Rockville, MD 20857

DHHS Publication No. (SMA) 08-4359

Printed 2006

Reprinted 2008
1

SUICIDE: Helping Patients and 

Their Families

After an Attempt

as 

The emergency department (ED) is the

frontline of medicine and often serves 

the doorway into the medical system 

for people in distress, including people 

who attempt suicide. Individuals who 

have attempted suicide are at increased 

risk for later dying by suicide, and up 

to 20 percent of those who attempted 

suicide in the past will try again in the 

future.1

 The ED is often the initial point 

of contact with the health system for 

many of these individuals, and it offers a 

unique opportunity to help people who 

have attempted suicide to begin to recover 

from the depression and hopelessness that 

led to their suicide attempt. 

The purpose of this brochure is to provide 

you with some quick tips to enhance care 

in the ED for people who have attempted 

suicide, while also providing information 

on the Health Insurance Portability and 

Accountability Act (HIPAA), patient 

discharge, and resources about suicide for 

medical professionals, patients, and their 

families.

1 Appleby L., et al. Suicide Within 12 Months of Contact With Mental 

Health Services: National Clinical Survey, British Medical Journal

318(7193):1235-1239, May 1999.
Patient Care in the Emergency 

Department: Helpful Tips 

Medical and psychological assessment and 

the development of a suicide prevention 

or safety plan are key steps in treating 

an individual who has attempted suicide. 

Your medical training no doubt provided 

you with the tools to perform a thorough 

assessment of an individual who has 

attempted suicide, including exploring 

physical conditions that may contribute 

to a person’s behavior. However, for 

more information on this topic, the 

American Psychiatric Association’s 

Practice Guideline for the Assessment 

and Treatment of Patients With Suicidal 

Behaviors is an excellent resource 

(http://www.psych.org/psych_pract/treatg/

pg/pg_suicidalbehaviors.pdf or call 703-

907-7300).

In addition to your assessment, 

communicating with others who may 

have more information about a patient’s 

history, such as a family member or 

another physician, often can provide 

valuable insight as you assess the patient’s 

situation. Any such communications 

about a patient’s protected health 

information must be in accordance with 

the Federal patient privacy standards 

known as the HIPAA. Here are some brief 

highlights of HIPAA: 

2
Communicating With a Patient’s 

Family or Other Caregiver 

• 

• 

• 

â If the patient consents to his or her

information being shared.

â

â

HIPAA allows the disclosure of 

protected health information to a 

family member or caregiver in the 

following situations:

If an emergency physician, based on his 

or her best medical judgment, feels the 

patient lacks the capacity to provide 

informed consent, and that disclosure 

is in the patient’s best interest, 

then the emergency physician can 

communicate directly with a patient’s 

family or other caregiver, even if a 

patient objects.

However, information shared with 

family members or other caregivers 

should be limited to that which is 

directly relevant to the caregiver’s 

involvement with the patient’s care or 

payment for that care.

Remember: Although confidentiality laws 

may restrict you from communicating 

medical information to nonmedical 

attendants, HIPAA allows you to receive 

unlimited information from families or 

other caregivers without patient consent. 3
Communicating With Other Medical 

Professionals About a Patient

If possible, consult with an individual’s 

inpatient and/or outpatient provider to 

help maintain continuity of care and 

allow for informed decisionmaking by the 

individual and his or her treatment team. 

As long as a good faith effort has been 

made to inform your patient about your 

institution’s privacy practices, HIPAA 

allows you to:

• 

• 

Share information about the person with 

other medical providers who are involved 

in the person’s care, both within and 

outside of your own institution. This 

applies to all forms of communication 

(e.g. verbal, electronic, written).

Provide your name and contact 

information to another medical provider 

for communication about the person.

To read more about HIPAA online, visit 

http://www.cms.hhs.gov/hipaa.

Patient Discharge From the 

Emergency Department: What the ED 

Can Do To Ease the Transition

In addition to your assessment and 

interventions for a person in the ED, a 

well-conceived discharge plan will go a 

long way in helping people safely and 

successfully begin to recover. Here are a 

few things to consider when developing a 

person’s discharge plan.

4
Before leaving the ED, it is recommended 

that the patient and his or her family, if 

appropriate, should have:

• 

• 

• 

• 

An understanding of discharge 

arrangements.

A written statement with information 

about prescribed medication(s) and 

treatment plans.

Key contacts to call—including 

outpatient providers, crisis lines, and 

peer-support centers.

Specific instructions about the signs,

symptoms, or conditions that require a 

return.

Other key points to discuss with patients 

and families before discharge include:

•

•

•

•

•

What to look for that may indicate a 

return of suicidal feelings.

Followup care—Who? Where? When?

How to get resources and supports in 

the community.

How to reduce the immediate hazards 

of another suicide attempt (such as 

information on removing or restricting 

items that are frequently used for selfharm).

Who to call with questions or concerns.

5
If a patient is being discharged and an

appointment for followup care cannot 

be arranged before discharge, strongly 

encourage the patient to seek followup 

care within the first few days of returning 

home. In areas where this service is 

available, mobile crisis teams have been 

effective in helping patients in crisis 

connect with outpatient treatment 

following an emergency visit. Consider 

linking your patient with a team in your 

area to increase the chances that he or she 

will access followup care. 

Also remind your patient that the 

emergency department is open 24 hours a 

day, 365 days a year to help, if he or she 

continues to have thoughts of suicide or if 

the medical team is unavailable to provide 

the needed care. 

One of the most important things you can 

do for a patient or family member after 

having been in the ED is to offer hope. 

Patients and families will look to you to 

determine the prognosis and for some 

assurance that this will not happen again. 

While you cannot guarantee there will not 

be a recurrence, you can assure them that 

recovery is likely if the individual and, if 

appropriate, a family member work closely 

with a therapist to ensure that the safety 

and treatment plans are meaningful and 

effective.

The following pages of this brochure offer 

a list of crisis lines and referrals for more 

information on suicide and mental illness 

6
for patients and their families. Please 

also consider providing your patient with 

a copy of the brochure Suicide: Taking 

Care of Yourself After an Attempt, and 

its companion brochure for families, 

Suicide: Taking Care of Family Members 

After an Attempt. Each brochure includes 

information on safety and recovery, as 

well as additional resources for help.

Following these tips should increase the

likelihood that your patients who have

attempted suicide find the longer-term 

care that will prevent another attempt—

one that could be fatal. You and the 

professional team around you can make 

the difference.

Resources for Professionals in the 

Emergency Department 

The following resources offer excellent 

information on suicide and patient 

assessment.

American Association of Suicidology

A resource and education organization 

dedicated to the understanding and 

prevention of suicide. For more information, 

visit http://www.suicidology.org or call 202-

237-2280.

American College of Emergency 

Physicians (ACEP)

A national medical society committed to 

advancing emergency care through continuing 

education, research, and public education. For 

more information, visit http://www.acep.org or 

call 1-800-798-1822.

7
American Foundation for Suicide 

Prevention (AFSP) 

The AFSP has recently produced an excellent 

poster for emergency physicians on the 

evaluation of patients who attempt suicide; to 

obtain a free copy, visit http://www.afsp.org or 

call 1-888-333-AFSP. 

American Psychiatric Association 

Practice Guideline for the Assessment and 

Treatment of Patients with Suicidal Behaviors 

Visit http://www.psych.org/psych_pract/treatg/

pg/pg_suicidalbehaviors.pdf or call 703-907-

7300. Gliatto, M. and Rai, A., Evaluation and 

Treatment of Patients with Suicidal Ideation. 

American Family Physician, March 15, 1999. 

Full text available online at http://www.aafp.

org/afp/990315ap/1500.html.

National Strategy for Suicide 

Prevention 

A comprehensive national plan that 

lays a framework for action to prevent 

suicide. For more information, visit 

http://www.mentalhealth.samhsa.gov/

suicideprevention.

Suicide Prevention Resource Center

Supports suicide prevention with the best 

of science, skills, and practice. For more 

information, visit, http://www.sprc.org or call 

1-877-GET-SPRC (438-7772).

8
Resources for Patients and Families 

in the Emergency Department

In a crisis, contact:

1-800-273-TALK (8255) 

Veterans, press 1.

TTY: 1-800-799-4TTY (4889)

National Suicide Prevention Lifeline

A 24-hour, toll-free crisis hotline that links 

callers to a nearby crisis center. 

http://www.suicidepreventionlifeline.org

For more information about suicide and 

mental illness:

American Association of Suicidology

A resource and education organization 

dedicated to the understanding and 

prevention of suicide. 

http://www.suicidology.org or call 202-237-

2280

American Foundation for Suicide 

Prevention 

Dedicated to advancing the public’s 

knowledge of suicide and its prevention. 

http://www.afsp.org or call 1-888-333-AFSP

Befrienders International/Samaritans

An online resource that gives support through 

e-mail and offers a directory of local crisis 

helplines. 

http://www.befrienders.org 

9
Covenant House Nineline Hotline 

1-800-999-9999 

A 24-hour, toll-free crisis hotline offering 

confidential and immediate crisis intervention 

and referrals to community resources. 

http://www.covenanthouse.org/programs_

nl.html 

Hispanic Community Resource 

Helpline

1-800-473-3003 

(La Linea Nacional de Ayuda) 

Offers support for Latinos who need 

information about educational, health, and 

human service providers.

Link’s National Resource Center for 

Suicide Prevention and Aftercare 

(LINK–NRC) 

Provides suicide-related community education 

in prevention, intervention, aftercare, and 

support. 

http://www.thelink.org or call 404-256-9797

Mental Health America 

Addresses all aspects of mental health and 

mental illness. 

http://www.nmha.org or call 1-800-969-NMHA 

(6642)

National Alliance on Mental Illness 

(NAMI) 

Offers information, support, and advocacy for 

persons affected by mental illnesses. 

http://www.nami.org or call 1-800-950-NAMI 

(6264)

10
National Disability Rights Network

Serves individuals with a wide range of 

disabilities by guarding against abuse, 

advocating for basic rights, and ensuring 

system accountability. The Web site provides 

a directory of member agencies by State.

http://www.ndrn.org or call 202-408-9514 or 

202-408-9521 (TTY)

National Institute of Mental Health 

(NIMH)

The leading Federal agency for research on 

mental and behavioral disorders. 

http://www.nimh.nih.gov or call 1-866-615-

6464

National Organization for People of 

Color Against Suicide 

Addresses and raises awareness about suicide 

in minority communities.

http://www.nopcas.com or call 1-866-899-5317

SAMHSA Health Information Network

The SAMHSA Health Information Network 

connects the behavioral health workforce and 

the general public to the most current and 

comprehensive information on the prevention 

and treatment of mental and substance 

use disorders. To speak with a trained 

Information Specialist (English/Spanish):

For treatment referrals, call 1-800-662-HELP 

(1-800-662-4357) 24 hours a day, 7 days a 

week.

For all other inquiries, call 1-877-SAMHSA-7 

(1-877-726-4727) M – F, 8 a.m. – 8 p.m. ET 

http://www.samhsa.gov

11
Suicide Awareness Voices of Education 

(SAVE) 

Dedicated to preventing suicide through 

education, public awareness, and stigma 

reduction. 

http://www.save.org or call 952-946-7998

Suicide Prevention Action Network 

(SPAN) USA 

A national organization dedicated to action 

and advocacy for suicide prevention. 

http://www.spanusa.org or call 202-449-3600

Suicide Prevention Resource Center

Supports suicide prevention with the best of 

science, skills, and practice. 

http://www.sprc.org or call 1-877-GET-SPRC 

(438-7772)

The Trevor Helpline 

1-866-4U-TREVOR 

A national 24-hour, toll-free suicide prevention 

hotline aimed at gay and questioning youth. 

http://www.thetrevorproject.org

These resources may contain materials that 

express views, policies, and opinions that do not 

necessarily reflect those of the Substance Abuse and 

Mental Health Services Administration and the 

U.S. Department of Health and Human Services.

12
Your Notes Here:

13
Your Notes Here:

14
For More Information:

Printed 2006 • Reprinted 2008

DHHS Publication No. (SMA) 08-4359