Predicting and Preventing Suicide at Entry to Mental Health Care: A Community-Engaged, Machine Learning Model Implementation.

Suicide rates in the United States have increased steadily over the past 20 years, a trend coinciding with rising use of mental health services across the country. To help patients before a suicide attempt, health systems must be able to screen for suicide risk and take action at a large scale. Recently, powerful machine learning (ML) models have emerged that can accurately predict suicide attempts by using historical electronic health record data, and yet there exists no standardized framework for implementing these models in care delivery. In this article, the authors present a case study describing the deployment of a suicide risk prediction model within a large virtual mental health care program at Kaiser Permanente Northern California that handled more than 5000 intake visits per month. Their approach used data science to evaluate model validity for their novel use case (intake visits). They integrated patient and clinician voices to design a model-augmented suicide assessment workflow, which they tested iteratively with continuous input from clinician managers. Understanding the opportunities and pitfalls of model-augmented suicide risk assessment from the perspective of patients and clinicians provided an intuitive framework for mapping clinical actions to potential prediction scenarios. This playbook can be applied to ongoing codevelopment of ML uses as part of health systems' continuous learning initiatives, integrating ML to serve today's public health needs. (Funded by a Delivery Science Grant from The Permanente Medical Group.).