VHA National Center for Patient Safety

The MHEOCC has contributed to an 82 percent decrease in completed suicides in VA inpatient mental health units throughout the United States.

The Province of Alberta, Canada is implementing the Mental Health Environment of Care Checklist (MHEOCC) created by the VA National Center for Patient Safety (NCPS). Since its inception in 2007, the MHEOCC has contributed to an 82 percent decrease in completed suicides in VA inpatient mental health units throughout the United States.

The checklist is used to evaluate the safety of the environment of care of inpatient mental health units to ensure there are not hazards, such as anchor points for hanging, which patients could use for self-harm or harm to others. Every acute mental health unit throughout the Veterans Health Administration (VHA) is required to be inspected using the checklist every six months. If there are any hazards identified, the inspection team develops a plan to abate the hazard. These plans are then sent to NCPS for monitoring and also to create a shared mental model of potential hazards around the nation.

“The use of the MHEOCC in VHA has been associated with a reduction in the rate of inpatient suicide on mental health units. I am hopeful that the use of the MHEOCC by Alberta Health Services will help the Province reduce their rates of inpatient suicide on their mental health units as well,” said Dr. Peter Mills, MHEOCC manager and VA NCPS Field Office Director.
 
Alberta Health Services (AHS) recently conducted a Quality Assurance Review to address the increased number of elopements from mental health inpatient units. A recommendation from the review was that an environment risk assessment be conducted on all units throughout the Province. The MHEOCC was selected as the tool of choice.

An interdisciplinary working group with representation from Alberta Health Services’ five zones was established to review the checklist. Nine questions were added to specifically address the elopement risks. The checklist was also revised to include AHS practices and Canadian standards to make it more applicable for the desired use.

“The decision to use the Mental Health Environment of Care Checklist was based on its validation and comprehensiveness. It was also based on the Veterans Health Administration and the author’s collaboration and flexibility to add questions to further assess the risk of elopement,” said Fran Barnes, Manager of Zone Integration for AHS.

The Mental Health Environment of Care Checklist will continue to be used in VHA to ensure that Veterans needing acute mental health care will receive that care in a safe, healing, recovery-oriented environment. The flexibility of the checklist will allow VHA and other agencies like AHS adapt to the ever changing mental health environment of care and the patients that we collectively have the honor to serve.