Suicide and attempted suicides affect individuals of all demographic and socioeconomic backgrounds but those in lower socioeconomic status groups are disproportionately represented in these occurrences. According to the American Public Health Association (2018) fact sheet for preventing suicide, this healthcare issue costs the United States approximately $93.5 billion in loss of productivity and treatment for the sustained injuries. Additional losses including the emotional loss of those left behind weighs heavily on the overall population. With individuals in among the lower socioeconomic status groups relying either on state provided insurance or having no access to adequate healthcare, principle coverages of PCP’s depends highly on primary care rather than mental health services (Kroenke & Unutzer, 2017). For those without healthcare coverage, the emergency room departments serve as primary care (Petrik, Gutierrez, Berlin, & Saunders, 2015). Recognizing unemployment and economic stress as high predictors for suicide risks as noted by the American Public Health Association (2018), it is evident that a lack of access to adequate healthcare and mental health services stands as a significant barrier to preventing suicide and suicide attempts in the United States of America.

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Problem Statement
The problem that this proposal seeks to address is the limited access to effective mental healthcare screening and preventative measures for individuals who rely on the emergency room departments for primary healthcare. According to Petrik, Gutierrez, Berlin, and Saunders (2015) suicide risks are frequently undetected in these facilities leading to suicide attempts, suicides, and the associated negative implications of this healthcare issue. While nursing staff members are provided general training on these risk indicators, it is evident that the level of awareness is not adequate to meet the needs of the population (Crawford, et al., 2015). Therefore, it is within the scope of the problem that the current policies relating to treatment of the underprivileged in care facilities that are not adequately trained to assess these risks, is failing to address the issue of suicide.

Proposed Policy Change
While improving the overall access to healthcare and mental health services for the underprivileged is a feat worthy of ongoing advocacy, the urgency of this issue is depicted in the more than 420,000 attempted suicides per year (Petrik, Gutierrez, Berlin, & Saunders, 2015). Among these attempts, approximately 30,000 individuals in the nation die at their own hands (Bolster, Holliday, Oneal, & Shaw, 2015). For this reason, it is important that direct changes be made that will certainly achieve support within a shorter timeframe than a significant change to the healthcare system. Therefore, the current proposal addresses the placement of mental healthcare nurses in emergency room departments with mandates of at least one staff member per shift meeting this criterion.

According to Bolster, Holliday, Oneal, and Shaw (2015) current programs for suicide prevention include public awareness educational programs and media presented campaigns. However, the authors also found that most people who attempt suicide have visited a healthcare provider within the previous month. For those in the target population, a visit to an emergency room department has been documented within the previous year with many patients having been seen multiple times (Petrik, Gutierrez, Berlin, & Saunders, 2015). This indicates that the staff in these facilities are not well trained in identifying the signs and risk factors for suicide idealization and therefore fail to initiate preventative measures. However, Bolster, Holliday, Oneal, and Shaw (2015) note that mental health nurses have received adequate training and are able to identify the risks as well as direct the patient’s care towards mental health services or community programs. Yet, these professionals are most often employed at inpatient mental healthcare facilities despite also being able to practice in other settings.

A regulation that each facility must employ enough mental healthcare nurses to provide assessments and assist other nursing staff in identifying mental health issues including suicide idealization would not only expand the scope of knowledge within the nursing profession, but also ensure that those who do not have regular access to primary care or mental health services do not continue to fall through the gaps of the healthcare system. Such a regulation can be tied to state and federal relief for uninsured patients which would help to ease the cost of the additional staffing. Furthermore, the reduction of return visits and injuries would reduce the demand for healthcare in the target population.

Advocacy Plan
In order to promote the proposed change, an extensive review of the literature will be conducted to serve as the foundation of evidence for the course of the advocacy. This will then be directed towards the administration in the current facility with proposed salaries and a presentation of the scope of practice for mental healthcare nurses. Gathering retrospective data as to the number of suicide attempts and suicides in connection with the facility, a cost benefit analysis will support the need for this change within the facility. Following implementation of the evidence based practice in the facility, data will be collected at monthly intervals. A six month comparison study is anticipated to show a significant decrease of suicide attempts reported at the facility. Additionally, the data will show a reduction of costs associated with suicides due to the risk assessment.

This data will then be used to facilitate a formal plan of advocacy to achieve a state level mandate. Working closely with the legislators, it is anticipated that statewide changes will elicit support for a federal legislation that will acknowledge the population’s need and implement the proposed changes as a federal mandate. While the scope of this goal is extensive, it is notable that the movement forward from facility to federal changes will require additional evidence to ensure success. Therefore, each stage of the advocacy plan will move the healthcare profession closer to addressing this problem.