Continuity of Care as Suicide Prevention: Measures and Models to Consider for Nurses Serving People With Experiences of Homelessness

BACKGROUND: People with experiences of homelessness are at higher risk for suicide-related thoughts, behaviors, and deaths by suicide compared to those without homeless experience. This complex risk can be tied in part to extreme social need and multimorbidity. To meet these needs and reduce this risk, people with experiences of homelessness frequently require care from multiple providers. Continuity of care is protective against suicide risk, with care coordination playing a central role. Despite the importance of continuity of care in suicide prevention and the potential for mental health nurses to provide care coordination, few studies have explored this potential in relation to people with experiences of homelessness. OBJECTIVE: Provide a potential practice application to illustrate the possible value of using the Alberta Continuity of Services Scale for Mental Health (ACSS-MH) to measure and improve continuity of care as an important element of suicide prevention for people with experiences of homelessness. METHODS: Using the U.S. Department of Veteran Affairs (VA) Homeless Patient-Aligned Care Team (HPACT) model and universal VA suicide risk screening protocol as a practice exemplar, we discuss the ACSS-MH subscales to illustrate a potential care delivery evaluation and way the psychiatric nursing community can optimize continuity of care, suicide risk detection and suicide prevention in this population. RESULTS: Innovative screening and practice models are needed to effectively prevent suicide in high-risk populations, like people with experiences of homelessness. This case study provides insight into the ACSS-MH measure and VA-based homeless-specific primary care as an example of how psychiatric nurses could similarly use this measure to impact the safety of patients with experiences of homelessness by intentionally fostering continuity related to suicide prevention. CONCLUSIONS: This discussion of a practice application shows how the use of a validated measurement tool could drive quality improvement and research that begins with the measurement of continuity related to suicide prevention for high-risk populations.