Benefits and Drawbacks of Universal Suicide Screening

The Controversies in Psychiatric Services column aims to highlight differing viewpoints on topics relevant to psychiatric services that have generated a debate or divide in opinion. For this column, the editorial team chose to focus on the issue of universal suicide screening, asking authors to respond to the following statement:

Universal suicide screening in all settings that see behavioral health patients, including nonbehavioral health general hospital settings, is the best approach to address suicide risk in the population.

Even though there is little debate that suicide represents a worsening national epidemic in need of increased attention, there is debate whether universal screening represents the best path forward compared with targeted assessments. Goldstein Grumet and Boudreaux lay out a clear argument for universal screening across all health care settings for several reasons; most important, screening should cast as wide a net as possible to proactively identify at-risk individuals, because many at-risk individuals are not in regular contact with behavioral health specialists. However, Bryan, Allen, and Hoge argue for targeted suicide screening to decrease the number of false positives and to ensure that critical behavioral health resources are used where most needed. Moreover, Bryan et al. contend that universal screening in nonbehavioral health care settings is at best insufficient and at worst deleterious, because fidelity to the screening tools may be lacking. Behavioral health providers across the country are both motivated to respond to the suicide epidemic in the United States and acutely aware of the unintended consequences of new requirements and regulations. Reading these two perspectives, we hope, will offer readers clarity as to the value—and cost—of suicide screening.