Serious mental illness and suicidal ideation are two of the largest problems in American healthcare today. In fact, while one-in-five American adults have any mental illness, approximately 1 in 20 adults in the U.S. are affected by serious mental illness, or a mental illness that significantly impacts the ability to function in one or more aspects of everyday life. Meanwhile, suicide is the twelfth leading cause of death overall for all populations in the U.S., and the second leading cause of death in children between the ages of 10 and 14. The relationship between death by suicide and unmanaged mental health conditions or low access to mental health services is well documented in recent research. Current research also highlights the continued rise in mental health symptoms and diagnoses among Americans given recent world events. The need to address serious mental health and suicide risk is greater than ever. The relationship between death by suicide and unmanaged mental health conditions or low access to mental health services is well documented in recent research. Current research also highlights the continued rise in mental health symptoms and diagnoses among Americans given recent world events. The need to address serious mental health and suicide risk is greater than ever.
Fortunately, there are steps that can be taken to address the need for greater mental healthcare, specifically screening early and consistently and using screenings as a way to offer the individualized support needed. By learning to screen individuals, behavioral health practitioners can offer help to those affected by mental illness before it becomes overbearing.
In this article, we’ll discuss the warning signs of serious mental illness and suicidal ideation that behavioral health staff should know, as well as the basics of mental health screenings and suicide risk assessments that can help healthcare staff in any setting more effectively work with clients struggling with their mental health.
Setting the Stage: The Causes of Mental Illness
Most serious mental health conditions begin by early adulthood. Research has shown that 50% of lifelong mental illnesses begin by age 14 and that 75% present by age 24. Therefore, this article will be geared toward working with and identifying these conditions among younger individuals. But the lessons from this article can, and should, be applied to people of all ages when the need arises.
There are many factors that contribute to the presence of mental illness. Genetic, experiential, and social factors all contribute to one’s mental health. Among younger populations, especially those from historically marginalized groups, the influence of stigma about mental illness and seeking behavioral healthcare cannot be understated. In fact, research has shown that those who feel stigmatized are 50% less likely to seek treatment.
This potential reluctance to seek help is one of the big reasons why mental health screenings are so important. By normalizing the screening process, healthcare providers can help mitigate the stigma of talking about mental health symptoms and conditions. For example, a primary care provider might normalize the screening process by asking every patient seen to answer questions about mood in recent weeks. By working with other caregivers and organizations in your area, such as general practitioners, youth groups, and schools, your organization can work with local populations to discover where care gaps exist.
But when your staff members conduct these screenings what should they look for?
Warning Signs: Know What to Look For
There is a multitude of warning signs for both serious mental illness and suicidal ideation. For behavioral health specialists, it is crucial to learn how to recognize these signs in order to help their clients as well as teach other healthcare professionals how to know when a client is at risk.
Unfortunately, there is no one sign for serious mental illness. Different conditions will present differently. With that said, there are several red flags that behavioral health specialists can look for in order to justify taking further action. While this is not a complete list, some of the most prominent symptoms of untreated mental health conditions include:
- Changes in sleep or appetite
- Excessive anxiety, fear, or worry
- Frequent feelings of sadness
- Feeling disconnected and/or withdrawing from social behavior
- Changes in behavior or mood
Though the appearance of one or two of these symptoms may not point to serious mental illness, if a patient is exhibiting several of these symptoms further assessments may be warranted. If left untreated, an individual experiencing mental illness may begin to experience suicidal ideations.
There are some similar signs of suicidal ideation and serious mental illness, such as increased feelings of sadness and/or anxiety, and changes in behavior. But there are also definite signs of suicidality that behavioral health specialists need to be aware of. These include:
- Talking about wanting to die, becoming a burden on others, and feelings of guilt or shame.
- Emotional pain so strong it does not seem bearable.
- Planning or researching ways to die.
- Giving away important items, making a will, and/or saying goodbye to family and friends.
If you recognize these signs in your clients, knowing what to do next will prove critical to keeping them safe and helping them heal.
Conducting Mental Health Screenings and Suicide Risk Assessments
Mental health screenings are an important first step in working with clients who may be experiencing mental illness. By incorporating this tool into your organization’s workflow, you can better gauge the conditions that your clients are coping with, as well as the severity of these conditions.
To conduct these initial screenings, you can ask clients to describe their mindset, feelings, and behavior. Through this questionnaire, trained staff members should be able to deduce the mental health condition (if any) that the client is experiencing. It may also be advisable to employ or partner with nurses or physicians who can properly screen for testable conditions such as vitamin deficiencies, thyroid disease, and others that can lead to mental illnesses such as depression.
If you’re worried that a client or clients may be experiencing suicidal ideation, a suicide risk assessment would be the next step. To conduct these assessments, use language such as the following:
- “I understand these questions may be uncomfortable to answer. I ask them because I value helping all my clients stay safe.”
- “I want to take as much time as you need to talk about these next few questions.”
- “It’s common for people to think about being better off dead when experiencing tragedy or stress, let’s talk about how you’re doing.”
- “I have these questions for you to answer on this form, but let’s talk about them together first.”
When conducting these assessments, it’s critical to not rush or minimize the assessment in any way. By giving your client your full attention, you’ll be better able to determine their risk of suicide and how best to help them move forward.
Rola Aamar completed her PhD in Marriage and Family Therapy from Texas Tech University, where she focused her clinical research on vulnerable populations and the importance of treatment alliance between patients, the family, and healthcare providers. Aamar was a SAMHSA Minority Fellowship Program fellow from 2014-2015. She has years of behavioral health clinical experience working with multidisciplinary healthcare teams in primary and specialty treatment where she implemented clinical protocols to address social and relational barriers of care. She is currently a Partner for Behavioral Health Solutions at Relias, bringing her clinical and operational knowledge of integrated care, clinical research, and behavioral healthcare to support client use of population performance data to improve clinical performance and patient health outcomes. In this role, she provides clinically informed, data-driven consulting to clients to promote performance improvement.
For more than 11,000 healthcare organizations and 4.5 million caregivers, Relias continues to help clients improve clinical and financial outcomes by reducing variation in care. We help healthcare organizations, their people, and those under their care, get better. Better at identifying problems, addressing them with better knowledge and skills, and better outcomes for all. Learn more at www.relias.com.
- S. Department of Health and Human Services. (n.d.). Mental illness. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/mental-illness
- Mental health by the numbers. NAMI. (n.d.). https://www.nami.org/mhstats
- Aamar, R. (2023, April 19). Countering stigma through education and Outreach. Behavioral Health News. https://behavioralhealthnews.org/countering-stigma-through-education-and-outreach/
- Warning signs of mental illness. Psychiatry.org – Warning Signs of Mental Illness. (n.d.). https://www.psychiatry.org/patients-families/warning-signs-of-mental-illness
- S. National Library of Medicine. (n.d.). Depression screening: Medlineplus medical test. MedlinePlus. https://medlineplus.gov/lab-tests/depression-screening/
- Aamar, R. (2023b, May 15). Suicide risk assessment: How to talk about suicidal ideation. Relias. https://www.relias.com/blog/suicide-risk-assessment