Workforce Investments in Telehealth Suicide Prevention in Emergency Departments: Implementation Costs of a Centralized Behavioral Health Consultation Service.

Authors

Freya Nezir, Megan E Reilly, Michael Steinberg, Kelly L Green, Shari Jager-Hyman, Courtney Benjamin Wolk, Danielle Mowery, David S Mandell, Maria A Oquendo, Gregory K Brown

Published in

The journal of behavioral health services & research. Jun 23, 2026. Epub Jun 23, 2026.

Abstract

Health systems increasingly deploy telehealth suicide prevention in emergency departments (EDs), yet little is known about required organizational investments. Transparent resource estimates are needed to plan and scale behavioral health services in acute care. This micro-costing study examined implementation of a centralized Suicide Prevention Consultation Center (SPCC) delivering telehealth Safety Planning Intervention with follow-up (SPI +) to suicidal ED patients across eight hospitals. Using Time-Driven Activity-Based Costing (TDABC) from a health system perspective, implementation strategies were mapped to actions, personnel roles, and time drivers. Standardized wages were applied to calculate total and per-ED costs, distinguishing centralized from site-specific activities and classifying costs by implementation strategies and Exploration, Preparation, Implementation, and Sustainment (EPIS) framework phases. Over 14 months, implementation required 1824 staff hours costing $163,329 ($20,416 per ED). Clinician consultation, workflow development, and training accounted for three-quarters of costs. Most resources (84%) supported one-time centralized activities (e.g., EHR referral and system-wide workflow design), while 16% supported site-specific activities such as ED leadership engagement, local workflow adaptation, and go-live meetings. Preparation-phase activities comprised 62.5% of costs; implementation-phase supports comprised the remainder. Costs were concentrated among the SPCC Clinical Consultant, Implementation Lead, and SPCC clinicians (71% of total), with additional opportunity costs borne by health system leadership and clinical personnel. Launching a centralized telehealth suicide prevention service in EDs requires substantial but time-limited behavioral health workforce investments, particularly clinical consultation, workflow development, and training to build clinician capacity and fidelity. These findings provide practical benchmarks for health systems considering scalable telehealth suicide prevention services.

PMID:
42337210
Bibliographic data and abstract were imported from PubMed on 24 Jun 2026.

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