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Algorithm for level of care for medically stable adults who initially present to their outpatient clinician with suicidal ideation (thoughts)*

Algorithm for level of care for medically stable adults who initially present to their outpatient clinician with suicidal ideation (thoughts)*
* This algorithm provides an overview to help determine the level of care for adults who initially present to their outpatient clinician with suicidal ideation. However, there are no evidence-based criteria for determining level of care. Medically stable patients who present with suicidal behavior should receive an immediate psychiatric assessment in an emergency department or crisis clinic.
Determining the level care requires a thorough psychiatric evaluation that serves to individualize the disposition, and includes the factors addressed in this algorithm, as well as other factors, such as past history of suicidal ideation and behavior, adverse childhood experiences, current and past psychopathology and general medical illnesses and response to treatment, psychosocial stressors, impulsivity, hopelessness, helplessness, worthlessness, and the availability of resources such as treatment facilities and support from others. These factors are used to judge the acuity of the suicidal ideation, the patient's readiness to act on a suicide plan, and the patient's capacity for maintaining safety. In many cases, the disposition (and treatment) will rest upon the outcome of a psychiatric evaluation in the emergency department.
¶ Refer to UpToDate topic on suicidal ideation and behavior in adults.
Δ Partial hospital (day program) typically provides care Monday through Friday for six to eight hours per day. Intensive outpatient programs provide less intensive care (eg, three days per week, for three hours per day).
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