Psychiatric consultation and referral of persons who have attempted suicide: The perspective of heads of emergency and psychiatry departments

Background: Persons who have attempted suicide are often admitted to a hospital’s emergency department (ED). The risk of them repeating their attempt is lower if they have had access to a psychiatrist in hospital and had been referred to mental health care services. However, the literature suggests this is often lacking. Aims: To describe perceived barriers to and supportive factors for psychiatric consultation and appropriate referral of suicide attempters in the ED. Method: The perspective of the heads of emergency and psychiatry departments in all hospitals with an ED in Brussels-Capital Region was investigated with a qualitative study. Data were obtained with semistructured personal interviews and analyzed in the tradition of content analysis. Results: Eight emergency physicians and 11 psychiatrists participated. Perceived barriers can be summarized as a lack of resources in the ED in terms of psychiatrists, psychiatric beds, and a room for counseling. Intense collaboration between physicians and psychiatrists and integration in a network of mental health services were perceived as being supportive factors. Conclusion: According to the heads of department, psychiatric consultation and referral of suicide attempters could be improved by an increase and more even distribution of beds for temporary psychiatric hospitalization in the ED and a more appropriate financing of the psychiatry function in the ED.