Preventing Suicide by Changing the Physical Environment

A checklist that helps staff identify and correct suicide risks in the physical environment of mental health units at Veterans Health Administration (VHA) hospitals is so effective that it should be used by other hospitals, according to the authors of a recent study. State and community suicide prevention practitioners can share these recommendations with local hospitals as a way to help them prevent psychiatric inpatient suicides.

The Mental Health Environment of Care Checklist (MHECC) helps staff identify 114 risks in the physical environment of mental health units that should be corrected to reduce suicide risk. These hazards include anchor points such as shower heads, towel bars, or closet hooks from which a patient could hang him- or herself, as well as room designs that prevent staff from monitoring patients who are at risk for suicide.

An analysis of data on all suicides in VHA inpatient mental health units (1999-2011) found that using the MHECC was associated with a 62 percent reduction in the suicide rate. During those same years, the psychiatric suicide rate in non-VHA hospitals decreased by only 21 percent. The suicide rate in VHA hospitals was 2.64 per 100,000 inpatient mental health admissions (and 2.08 per 1 million bed days of inpatient mental health care) prior to use of the MHECC. After the checklist was implemented, the suicide rate decreased to .87 per 100,000 inpatient mental health admissions (and .79 per 1 million bed days of inpatient mental health care). The authors maintain that their research “suggests that modification of the physical hospital environment alone can reduce the risk of inpatient suicide” and that the checklist could be effective in reducing suicide rates in other hospitals and healthcare systems. They also pointed out that there may be significant barriers – including cost – to implementing the MHECC in other settings.

Resource Note:
Download the MHECC at no cost

Watts, B., Young-Xu, Y., Mills, P., Derosier, J., Kemp, J., Shiner, B., & Duncan, W. (2012). Examination of the effectiveness of the Mental Health Environment of Care Checklist in reducing suicide on inpatient mental health units. Archives of General Psychiatry, 69(6), 588-592.