title: Sustained Effectiveness of the Mental Health Environment of Care Checklist to Decrease Inpatient Suicide.
abstract: OBJECTIVE
  The Mental Health Environment of Care Checklist (MHEOCC) has been reported to be effective in decreasing suicide on inpatient mental health units. The authors sought to examine whether the effect of the MHEOCC was sustained.
  
  
  METHODS
  Root cause analysis reports from all Department of Veterans Affairs (VA) hospitals were reviewed to obtain a count of suicides occurring on mental health units from 2000 to 2015. The number of mental health admissions and bed-days of care were obtained for the same period.
  
  
  RESULTS
  The rate of suicide prior to the implementation of the MHEOCC was 4.2 per 100,000 admissions or 2.72 per million bed-days of care. The rate after implementation was .74 per 100,000 admissions or .69 per million bed-days of care. There was no loss of effect in the seven years after implementation.
  
  
  CONCLUSIONS
  The MHEOCC was associated with a sustained reduction in suicides occurring on inpatient mental health units.
authors.affiliation: The authors are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, and the National Center for Patient Safety, White River Junction, Vermont (e-mail: bradley.v.watts@dartmouth.edu ).
authors.forename: Bradley V
authors.initials: BV
authors.lastname: Watts
authors.affiliation: The authors are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, and the National Center for Patient Safety, White River Junction, Vermont (e-mail: bradley.v.watts@dartmouth.edu ).
authors.forename: Brian
authors.initials: B
authors.lastname: Shiner
authors.affiliation: The authors are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, and the National Center for Patient Safety, White River Junction, Vermont (e-mail: bradley.v.watts@dartmouth.edu ).
authors.forename: Yinong
authors.initials: Y
authors.lastname: Young-Xu
authors.affiliation: The authors are with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, and the National Center for Patient Safety, White River Junction, Vermont (e-mail: bradley.v.watts@dartmouth.edu ).
authors.forename: Peter D
authors.initials: PD
authors.lastname: Mills
mesh_terms: D057189:Checklist; D006760:Hospitalization / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs; D000092864:Suicide Prevention
keywords: Suicide &amp; self-destructive behavior, Inpatient treatment, Mental health systems/hospitals, Quality improvement, Veterans issues