In the month following a psychiatric discharge after an attempted suicide, a person is up to 300 times more likely to make another attempt than the general population. The risk is highest in the first hours and days – when the individual is often overwhelmed or hopeless.
That’s where the Hospital Follow-Up Program (HFUP) comes in.
Soft launched in September 2024 and statewide in November of that year, the program provides free telephonic crisis support and other follow-up services to patients in Colorado who have received behavioral health services in an emergency department (ED) or other urgent care facility.
Outreach at a critical time
“The basis of the program is to really reach patients during that high-risk, critical period, between discharge and those first 72 hours,” said Nina Brathwaite, PhD, MAFP, manager of the program.
The takeaway
Follow-up care is urgently needed for people who have visited emergency departments or psychiatric clinics due to overdose or other forms of self-harm. The Hospital Follow-Up Program bridges this critical care gap by providing telephonic crisis support to individuals early in their recovery process.
Over 18 months, the program has received 8,400-plus referrals from hospitals, and 30% of those patients fall between ages 10 and 19. Half of those identify as female, 45% as male, and 5% as transgender, gender non-conforming or non-binary.
Brathwaite said “it’s really concerning” to see the youth statistics, as increasingly younger patients are being referred. “The average age of the youth is 13.9 years, while the average age for adults tends to be 32 or 33.”
Strong participation by referred patients
Brathwaite said the idea behind HFUP is that discharge is only the beginning for patients who are struggling with where to turn. Recovery is typically a long road requiring steady support and guidance toward community resources.
Key points
- The Division of Community, Population, and Public Mental Health in the Department of Psychiatry collaborated with the Colorado Department of Public Health & Environment and the Second Wind Fund to launch the Hospital Follow-Up Program (HFUP). The Colorado Health Foundation is also a key partner.
- In the month following a psychiatric discharge, a person is up to 300 times more likely to attempt suicide than the general population.
- In its first 18 months, the HFUP received over 8,400 referrals from Colorado hospitals, and 30% of those patients are age 10 to 19.
HFUP specialists reach referred patients through Caring Contacts, an evidence-based suicide prevention intervention. The contacts – made via telephone, email and one-way texting – help patients stay on track with their safety plans and encourage them to stick to outpatient follow-up appointments.
Follow-Up Program specialists make first contact within three days of discharge – usually by phone, but also by email – when patients are extremely vulnerable and often overwhelmed by the process, Brathwaite said. “When we initially contact patients, they often decline, saying, ‘Oh, I just got this big stack of (discharge) papers, so I think I’m good.’ We often say, ‘OK, we can talk about them together, if you find that helpful.’
“It’s all about giving the patient what they need, and it’s consent-based.” Brathwaite said patient response has been strong: 83% of referred individuals either talk with a program specialist directly or make contact following a voicemail or email.
“The barriers to making consistent contact tend to be people who are unhoused,” she said.
Check-ins extend to parents, caregiving partners
One of the biggest challenges the specialists face is helping patients stay on track with the safety plans provided by the hospitals, as well as getting them to stick to outpatient follow-up appointments. National statistics show that only 30% of patients leaving the ED after a suicide attempt attend their first outpatient appointment.
Strong hospital participation
Currently, 63 hospitals across Colorado have referred patients to HFUP. The evidence-based transition service is a collaboration among:
- the Division of Community, Population, and Public Mental Health in the Department of Psychiatry at the CU Anschutz School of Medicine;
- the Colorado Department of Public Health & Environment’s Office of Suicide Prevention;
- The Colorado Health Foundation;
- the Second Wind Fund, which connects youth under age 19 with no-cost, suicide-specific therapy;
- and health systems across the state.
The check-ins extend to parents of youth and caregiving partners of adult patients.
“We try to address the most high-risk area for patients,” Brathwaite said. “We’re very honest about what we can do – call and check in and support you, provide resources and remind you remind you that there is support and people who care. Support is our foundation because we know that, for some people, they feel the system doesn’t have a place for them. We want to always communicate care and acceptance. Most importantly, it’s critical that they know the scope of our services so they know what to expect.”
So far, over 430 providers have participated in the program. About 40% of referrals are from rural areas of Colorado.
“I think the reason the program took off here was because it's become somewhat of a nationwide expectation that, following discharge from emergency departments and inpatient psychiatric units, there needs to be some kind of planned follow-up,” she said.
The program’s five-person team – as well as lead psychiatrist Scott Simpson, MD, MPH, director of the Division of Community, Population, and Public Mental Health, and Viki Manley, MA, division administrator – continue to monitor outcome data during this startup period where “we’ve been building the plane while flying it.” Brathwaite said the program’s ongoing goals include:
- Improving the health records system and tracking self-harm outcomes across systems.
- Delivering different levels of intensity/complexity of safer suicide care.
- Training suicide care providers across mental and behavioral health settings, including non-clinical staff.
Patient testimonials: success stories
Some of the best insight into HFUP’s impact has come through patient testimonials. One patient said, “This program is really cool. It felt really safe to talk to peers who’ve been there and done that. Sometimes I feel icky and judged speaking to a professional, but this didn’t.”
Another said, “Whoever thought of this program or built it is really doing a lot of good, and there needs to be more programs like this.”
National model
The National Action Alliance for Suicide Prevention cited Colorado’s Hospital Follow-Up Program as a successful model of robust care transition interventions in its report, 2024 National Strategy for Suicide Prevention.
Brathwaite, who has 25 years of experience working with patients across the lifespan, said she “accidentally” found telephonic crisis work during the pandemic and hasn’t looked back.
“We don’t have 300 people who can make calls,” Brathwaite said, “but I think, efficiency-wise, ours is a reliable model.”
While care contacts with patients typically span four to six weeks, that period can be extended if clinically indicated. Brathwaite said she still regularly checks in with a few patients who were referred 18 months ago. The program is also using interpretation services that allow specialists to communicate with patients in multiple languages, including American Sign Language.
“We always want to increase our reach and reduce barriers for the Colorado community,” she said.
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