A Guide to Suicide Prevention Tools Implemented by Array

Array Behavioral Care is committed to the Zero Suicide Model, emphasizing the importance of screening all patients to identify mental health needs and prevent suicides. Learn about the evidence-based, expert-informed suicide prevention tools we use to deliver high-quality care to every patient.

The PSS-3: Patient Safety Screener

The PSS-3 is a brief, primary screening tool designed for use in acute care settings to detect suicide risk. Developed by the University of Massachusetts Medical School, the PSS-3 serves as an initial triage tool to identify patients who may require further evaluation.

Key Features

• Quick administration with only three questions
• Designed for acute care settings
• Detects non-negligible suicide risk

Effectiveness Across Care Settings

The PSS-3's brevity makes it well suited for busy emergency departments and other acute care environments. By quickly identifying patients at risk, healthcare providers can direct those in need toward appropriate follow-up care and further assessment.

Important Reminders

• Always approach the patient with empathy
• The PSS-3 should be administered exactly as written, without modifications
• Pay attention to survey responses and body language for a complete understanding of the patient’s needs

The ESS-6: ED-SAFE Secondary Screener

For patients  who screen positive on the PSS-3, the ESS-6 provides a more comprehensive secondary assessment. This six-item tool helps clinicians further stratify suicide risk and determine the appropriate care pathway.

Components of the ESS-6

The ESS-6 assesses six critical indicators:

1. Passive and active suicidal ideation
2. Suicide method
3. Suicidal intent
4. Detailed suicide plan
5. Psychiatric history
6. Substance use and agitation

Simple Scoring System

Each indicator is scored, resulting in a total score ranging from 0 to 6. This scoring system offers a nuanced assessment of suicide risk, guiding clinical decision-making.

Assessing Risk Factors

The ESS-6 incorporates empirically supported risk factors for suicide, including:

• History of psychiatric hospitalization
• Prior suicide attempts
• Substance use
• Current state factors (e.g., intoxication and agitation)

Effectiveness and Validation

Research shows the ESS-6 has strong predictive validity for future suicidal behavior, making it an effective triage tool in acute care settings.

The Stanley-Brown Safety Planning Intervention (SAFE-T)

The Stanley-Brown Safety Planning Intervention provides a structured platform for clinician to collaborate with patients experiencing a suicidal crisis. In a 30–45-minute session, the clinician works with the patient to develop coping strategies and a personalized safety plan that includes assessing and mitigating lethal means.

Ongoing Personalized Support

The outcome is a written list of warning signs, internal and external coping strategies, mental health resources, and personal contacts for support. The plan is designed to be accessible outside of clinical settings, ensuring patients have a tangible resource during times of crisis. In addition, a key component involves eliminating or limiting access to any potential lethal means to provide a safe space for the suicide risk to subside.

Identifying Needs for At-Risk Individuals

The SAFE-T questionnaire is specifically intended for:

• Individuals with recent suicidal ideation
• Those with a history of suicidal behavior, including attempts, aborted attempts, or preparations for suicide
• Individuals determined to be at increased risk for suicide, but not requiring immediate intervention

Follow-Up as a Critical Component

A patient’s plan can be accessed outside of the walls of a clinic or a hospital to ensure continuity. Alongside virtual mental health support, consistency in care and establishing a rapport with a matched therapist can lead to improved patient outcomes.

• The clinician helps the patient decide where to keep the safety plan for easy access during crises
• The plan is reviewed and revised over time to ensure its effectiveness
• Ongoing assessment of the plan's usage and helpfulness is crucial for its success

Validation of Safety Planning

Research shows that implementing safety plans with patients reduced suicidal behavior by 43%. This highlights the importance of having safety plans in place, especially during transitions to outpatient care or in the weeks following a discharge from care when suicide has been shown to be more likely.

Best Practices for Suicide Screening Across Settings

When implementing screening tools, consider these assessments as the first step. Recognize that expressions of distress may extend beyond survey responses, requiring attentive and proactive psychiatric evaluations.

Case Study: The Power of Proactive Screening

In one case, a patient hesitated on a suicide screening question during a clinic visit. The onsite nursing staff sensed something was off and contacted the Array clinician for  further assessment. The patient disclosed they had a plan for self-harm, leading to the timely intervention and inpatient care they needed.

“I believe we saved a life that day,” said Dr. Shane W. Rau, MD, PhD, Medical Director for Measurement and Outcomes with Non-Acute Care at Array.

In Summary

Array's suite of suicide prevention tools offers a comprehensive approach to identifying and supporting individuals at risk. The PSS-3 provides a quick initial screen, the ESS-6 offers a more in-depth risk assessment, and the Stanley-Brown Safety Planning Intervention empowers patients with safety plans, coping strategies, and support networks.

Implementing these evidence-based tools can significantly strengthen suicide prevention efforts across healthcare settings. However, they should be integrated into a holistic approach that includes empathy, attentive care, and professional judgment. Follow-up care and access to ongoing support are essential for sustained impact.

Array’s experienced clinicians follow standardized practices with insight and compassion. For more information on Array's comprehensive mental health services, contact our team.

Together, we can make a difference in suicide prevention.