Notice Number: NOT-MH-19-030
Release Date: June 10, 2019
Response Date: August 30, 2019
National Institute of Mental Health (NIMH)
National Institute on Drug Abuse (NIDA)
National Institute on Alcohol and Alcoholism (NIAAA)
National Institute on Minority Health and Health Disparities (NIMHD)
Substance Abuse and Mental Health Services Administration (SAMHSA)
Veterans Affairs (VA)
Defense Suicide Prevention Office (DSPO)
American Foundation for Suicide Prevention (AFSP)
This Request for Information (RFI) seeks input on current clinical experience in the use of telehealth in ED settings to reduce suicide ideation and behavior, and to identify research gaps in the evidence base for providing this type of care. Information is sought from ED providers, as well as from telemental health services providers.
NIMH, NIDA, NIAAA, NIMHD, SAMHSA, VA and AFSP view the emergency care setting as a key opportunity for suicide prevention and overdose risk reduction. Among suicide decedents, nearly half had at least one ED visit in the year before death, and 20% in the month before death. At least 500,000 individuals present annually with self-injury and many more with suicidal ideation. These numbers, along with evidence that self-injury and suicidal ideation are major suicide predictors, suggest that effective methods to identify and treat individuals with suicide risk in EDs are essential to the effort to reduce the national suicide rate.
CDC reports Emergency department (ED) visits for opioid overdoses rose 30% in all parts of the US from July 2016 through September 2017. In some instances, it is difficult to distinguish between suicide and an overdose. EDs can play a key role in preventing repeat opioid overdoses by initiating treatment with Medications for opioid use disorder (MOUD); addressing uncontrolled pain; offering OD prevention by co-prescribing naloxone for those with OUD and providing linkages to outpatient SUD treatment and support services.
A growing body of evidence supports the feasibility and effectiveness of universal suicide-risk screening, and brief within-encounter interventions such as safety planning, and post-discharge interventions such as caring communications, telephone follow-up, along with indicated psychotherapy. Uptake of these practices in the ED remains insufficient. One key barrier consistently identified by the emergency medicine community is the limited access to mental health specialty consultation to help evaluate individuals identified as potentially suicidal, and to advise regarding appropriate triage of at-risk individuals. A recent study reported that approximately 20% of the nearly 5,300 EDs in the US report receiving telehealth consultation for psychiatry. However, it is not known to what degree these psychiatric consultations involved patient suicide risk assessment, suicidality management and/or referral for specialty mental health care.
The research evidence for the feasibility, safety, and efficacy of initiating treatment with buprenorphine (BUP) in the emergency department (ED) is now emerging. Initiating medication for OUD and linking patients with SUDs to treatment is an evolving practice and additional approaches are needed to augment current efforts. It is not known to what degree telehealth consultations are being provided in EDs for assessment and identification of overdose risk, SUDs, initiation of MOUD, and linkage to care.
NIMH, NIDA, NIAAA, NIMHD, SAMHSA, VA and AFSP are seeking input from the community to better understand and address research gaps in the implementation of telehealth health for suicide prevention and overdose risk reduction/prevention practices in emergency care settings.
This RFI seeks information from the community about their use of telehealth health in general hospital emergency medical care settings to facilitate the care of individuals with suicide risk.
From the perspective of the emergency medical (ED) setting, information on how the ED uses telehealth is being sought, with the responses to any or all of following topics of interest:
The nature of the telehealth service being used (telehealth company; hospital staff; contractors), and what contributed to the selection and implementation of those services; the characteristics of the ED with regard to urban/rural setting, health disparity populations reached, annual patient visits.
Information on the types of technologies used for ED telehealth consultation (e.g., close circuit video; telephone; app-based; asynchronous consultations, etc.)
Information on the approach used in the ED patients to identify suicide risk and associated risk factors across age groups (e.g., postpartum depression, multiple comorbidities including substance use and mental disorders). If multiple screening tools are used suicide, alcohol, and other drugs, describe the work flow and steps that follow a positive screen.
Within the work flow, what decision-making process guides when, and for which patients (e.g., age groups, race/ethnicity, minority or health disparity populations, socioeconomic status, geographic location, languages and interpreter services for those with low fluency in English) telehealth consultation is sought for suicide risk and overdose risk.
Describe the nature of the consultation, such as provider-to-provider consultation; and/or direct contact between the consultant and the patient. Information on the types of practices delivered by telehealth consultation, such as screening, evaluation, triage, intervention, disposition. Describe information on the financing mechanisms for the telehealth consultation services, and location of the provider or health system that initiated the consultation (e.g., urban versus rural, medically underserved area)
Include information on whether the telehealth consultation service been evaluated, and if so, what outcomes (e.g., repeat ED visits; hospitalization; other health care utilization; deaths) were examined, and over what period of time.
Describe practices related to accreditation (e.g., Joint Commission) when using telehealth health consultation (e.g., practices recoded appropriately; privacy risks minimized; and credentialing, privileging, and verifying qualifications), and how those were addressed.
Describe any pressing research questions about telehealth health services for suicide prevention and overdose risk reduction and prevention in the ED.
From the perspective of the telehealth services that provide consultation to EDs for suicide risk, overdose risk and/or related risk conditions, information regarding any or all of the following topics are of interest:
Describe the types of professionals (e.g., psychiatrists, addiction medicine physicians, psychologists, social workers, nurse practitioners, mental health and/or substance use disorder counselors, etc.) who provide consultations to the ED in your service.
Describe the nature of the consultation services provided, such as provider-to-provider consultation, and/or direct contact between your consultants and the patient. Describe the financing mechanisms used for your consultation service and location of the provider or health system to which consultation is offered (e.g., urban versus rural, medically undeserved area).
Describe the clinical scope of your service in determining risk for suicide, alcohol use disorder, and opioid use disorder, and associated work flows (e.g., assessment, diagnosis, brief interventions such as safety planning, referral) of the consultation. If patients are followed by your telehealth service after their ED visit, describe how this is done, and for how long.
Describe whether your consultation service has working/active referral relationships with local community-based outpatient mental health and/or substance use disorder treatment specialty clinicians or office-based OUD treatment providers for ongoing assessment and/or treatment of suicide risk. Provide information on how relationships with local entities were established, and how they function. If current military service or Veteran status queried, describe how that affects your practice (e.g., consultation with and/or referral to military service or VA providers). Describe any efforts to insure cultural sensitivity and linguistic needs.
If your telehealth service provides community crisis services, and/or works with local crisis services, describe if your efforts also work to divert patients from the ED in the future.
Describe any pressing research questions about telehealth services for suicide prevention and overdose risk reduction and prevention in the ED.
Submitting a Response
All comments must be submitted via email as text or as an attached electronic document. Your responses should be addressed to: ResearchRTF@mail.nih.gov by August 30, 2019. Please include the Notice number in the subject line. Response to this RFI is voluntary. Responders are free to address any or all of the categories listed above. The submitted information will be reviewed by the NIH staff.
This request is for information and planning purposes only and should not be construed as a solicitation or as an obligation on the part of the Federal Government. The NIH does not intend to make any awards based on responses to this RFI or to otherwise pay for the preparation of any information submitted or for the Government's use of such information.
The NIH will use the information submitted in response to this RFI at its discretion and will not provide comments to any responder's submission. However, responses to the RFI may be reflected in future funding opportunity announcements. The information provided will be analyzed and may be aggregated in reports. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted. No proprietary, classified, confidential, or sensitive information should be included in your response. The Government reserves the right to use any non-proprietary technical information in any resultant solicitation(s).
Please direct all inquiries to:
Jane Pearson, PhD
National Institute of Mental Health (NIMH)