In February 2015, Parkland Health—a large safety-net health system across Dallas—began universal suicide risk screening. A
study published in
Psychiatric Services shows that the effort paid off, as identification of at-risk patients increased fivefold in the five years after implementation.
Why It’s Relevant
Many individuals who die by suicide have some contact with the health care system in the weeks or months before their death. Universal screening across health care settings (not just emergency departments or psychiatric units) could be a pragmatic and proactive approach to identifying at-risk individuals. However, there is
debate about whether screening every patient is feasible or advantageous.
By the Numbers
- Investigators examined 5.2 million clinical encounters across Parkland’s outpatient, inpatient, and emergency settings that occurred between March 2010 and February 2020—five years before and after universal screening.
- Suicide risk was identified in 0.7% of all encounters before implementation and 3.5% of encounters afterward.
- In outpatient settings, suicide risk identification rose from just 0.04% to 1.6%.
- Relative increases in identifying risk were greatest among older adults, Black patients, patients who were divorced/separated/widowed, and patients who relied on self-pay or charity.
What’s More
Suicide risk detection remained low among Spanish-speaking patients following universal screening (<1%), suggesting a lingering equity gap perhaps related to linguistic, cultural, or structural barriers.
The Other Side
Because this analysis was based on clinical encounters, repeat encounters from high-utilization patients may have inflated some case counts. Further, another psychiatric facility in Parkland’s catchment area closed in 2018, which increased the volume of psychiatric encounters to their system.
Takeaway Message
The investigators noted that the implementation of universal screening was feasible at a high-volume, resource-constrained setting, which supports the practicality of incorporating standardized suicide risk assessments into routine workflows. However, they acknowledged that “the resource implications of broadened detection, including follow-up evaluations for positive screens that do not indicate imminent risk, merit careful characterization.”
Related Information
Source
Beth Childs, et al. Universal suicide risk screening in a safety-net health system: findings from 5.2 million encounters.
Psychiatric Services. Published October 6, 2026. doi:
10.1176/appi.ps.20260003
(Image: Getty Images/iStock/FatCamera)