1. Creating a Safe Environment:

• Physical Space:
  • Remove ligature points (belts, shoelaces, blinds, etc.) and hazardous materials (glass, razors, etc.).
  • Secure windows and doors.
  • Provide distraction materials (books, games, coloring books).
  • Maintain clean and comfortable space with adequate lighting.
• Social Environment:
  • One-on-one observation by trained staff or volunteers.
  • Open and honest communication, encouraging clients to express their feelings.
  • Support groups and individual therapy sessions (as available).
  • Limit visitors to approved individuals who will not trigger the client.

2. Admission and Discharge Considerations:

• Admission:
  • Complete comprehensive suicide risk assessment using standardized tools.
  • Document client’s plan, intent, and means of suicide.
  • Collaborate with case management for psychiatric placement within 24 hours.
  • Inform client of unit policies and safety procedures.
• Discharge:
  • Ensure safe discharge plan with follow-up appointments and crisis hotline information.
  • Communicate discharge plan with client, family, and receiving facility.

3. During Client Stay:

• Length of Stay:
  • Aim for minimal stay with continuous efforts towards psychiatric placement.
  • Monitor and reassess suicide risk regularly throughout the stay.
  • Avoid prolonged stays (ideally no longer than 24 hours) to prevent institutionalization.
• Allowable Items:
  • Soft clothing and shoes without laces.
  • Toiletries in unbreakable containers.
  • Books, pens, and paper for writing.
  • Limited non-hazardous craft materials.
• Restricted Items:
  • Belts, shoelaces, cords, ties, etc.
  • Glass, razors, metal objects, lighters, etc.
  • Drugs, alcohol, and cigarettes.
  • Sharp objects (pens, pencils, etc.) may require case-by-case assessment.

4. Client Monitoring:

• Frequency:
  • Continuous (one-on-one) for high-risk clients.
  • Every 15 minutes for moderate-risk clients.
  • Every 30 minutes for low-risk clients.
• Method:
  • Direct observation of behavior and verbalizations.
  • Open communication and active listening.
  • Monitoring room environment for potential hazards.
  • Documentation of observations and client interactions.
• Staff Responsibility:
  • All staff should receive training in suicide risk assessment and intervention.
  • Assigned observers should be trained and experienced in de-escalation techniques.
  • Regular team communication and handover to ensure continuity of care.

Additional Considerations:

• Cultural sensitivity: Respect individual differences and beliefs about suicide.
• Collaboration with family and support systems: Involve family members when appropriate and with client consent.
• Continuous policy review and update: Regularly evaluate and improve the policy based on best practices and experience.

Resources:

• American Foundation for Suicide Prevention: https://afsp.org/
• The Jed Foundation: https://jedfoundation.org/
• National Suicide Prevention Lifeline: 1-800-273-8255

Remember, suicide prevention is a collaborative effort. This policy framework serves as a starting point, and ongoing staff training, communication, and adaptation are crucial in ensuring the safety and well-being of suicidal clients in the observation unit.