Examination of the effectiveness of the Mental Health Environment of Care Checklist in reducing suicide on inpatient mental health units.
BACKGROUND
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).


METHODS
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.


METHODS
Implementation of the Mental Health Environment of Care Checklist.


METHODS
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.
VA National Center for Patient Safety, White River Junction, VT 05009, USA. bradley.watts@va.gov
Bradley V
BV
Watts
Yinong
Y
Young-Xu
Peter D
PD
Mills
Joseph M
JM
DeRosier
Jan
J
Kemp
Brian
B
Shiner
William E
WE
Duncan
D000328:Adult; D057189:Checklist / Q000592:standards*; D006778:Hospitals, Psychiatric / Q000592:standards*; D006801:Humans; D007297:Inpatients / Q000523:psychology; D001523:Mental Disorders / Q000175:diagnosis*; D017063:Outcome Assessment, Health Care / Q000592:standards*; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs; D000092864:Suicide Prevention