Practical management of the suicidal patient in the emergency department.
Wilson, M., Nordstrom, K., & Zeller, S.
Many of us have known someone, a relative, a colleague perhaps, who has attempted or died by suicide. Most of the time these tragedies come as a surprise. There are often few indicators that the person was contemplating taking his or her life.
It is often difficult to determine which patients are suicidal, especially if they are really intent on dying, and those who are simply making statements to attract attention. The new Joint Commission standard calls for extended if not universal screening for suicide ideology. Their intention is well-meaning; the literature sug- gests that many patients who later attempt suicide come to the emergency depart- ment (ED). However, many of these patients come to the ED for non-mental health reasons. Further, with more than 100 million visits per year, the ED simply sees a lot of patients and could theoretically be used to screen for anything.
Screening is one thing, but there then needs to be a plan for patients who screen positive. Current mental health resources are completely overwhelmed in most com- munities, particularly for the uninsured and those without adequate coverage. Adding more patients to a system that is already overflowing into our emergency departments will jeopardize care for many.
Finally, mental health procedures are legally more complex than physical health issues. Clearly there are legal implications if we discharge a patient who later harms himself. There are also implications, legally and emotionally, if we detain a patient against his or her will. Further, the rules regarding detention vary by state and may even mandate release of a patient who is not transferred to an inpatient facility within a set timeframe.