Detecting and Assessing Suicide Ideation During the COVID-19 Pandemic

BACKGROUND: The COVID-19 pandemic prompted a rapid shift to virtual (video and telephone) delivery of mental health care, disrupting established processes for identifying people at increased risk of suicidal behavior. METHODS: Following the shift to virtual care, Kaiser Permanente Washington implemented a series of workflow changes to administer standard screening and monitoring questionnaires at virtual visits and to complete structured suicide risk assessments for patients reporting frequent suicidal ideation. These new workflows included automated distribution of questionnaires via the electronic health record (EHR) patient portal and automated alerts to clinicians regarding indicators of high risk. RESULTS: In March 2020, in-person mental health visits were rapidly and completely replaced by video and telephone visits. The proportion of mental health visits with completed screening and monitoring questionnaires fell from approximately 80% in early 2020 to approximately 30% in late March, then gradually recovered to approximately 60% by the end of 2020. Among patients reporting frequent suicidal ideation on monitoring questionnaires, the proportion with a recorded suicide risk assessment fell from over 90% in early 2020 to approximately 40% in late March, then gradually recovered to nearly 100% by the end of 2020. CONCLUSION: Use of EHR patient portal messaging capabilities can facilitate systematic identification and assessment of suicide risk for patients receiving mental health care by telephone or video visit.