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Suicidal patients go unnoticed in A&E

  • 25 Comments

A&E departments are failing to spot patients who are at risk of committing suicide in future, many of whom seek emergency care in the year before their death, according to UK researchers.

They found more than 40 per cent of people who committed suicide over a two-year period in the north west had visited an A&E department at least once in the 12 months prior to their death.

Of these, 28 per cent had received emergency care on at least three occasions. These “frequent attenders” were more likely to have a history of self-harm.

“Clinicians should be alert to the risk associated with such presentations and to the possible association between frequent attendance and suicide,” the authors said online in the journal Emergency Care Medicine.

  • 25 Comments

Readers' comments (25)

  • Oh for gods sake, are we expected to be psychic as well now?

    In my experience sometimes the signs of depression are obvious yes, but not everyone who is depressed is suicidal. Also, a lot of those who are truly suicidal often show absolutely no clinical signs of depression or behavioural changes beforehand!

    Furthermore at the end of the day A&E staff are emergency personell, they are not mental health Nurses, or psychologists, or social workers or anything else. What exactly are we expected to do here?

    These people really should think before they come out with ridiculous statements such as this!

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  • Marjorie Lloyd

    I find the above comment offensive to nurses - all nurses are supposed to provide holistic care that means assessing for risk of suicide too which is an emergency btw. We do not have a seperate emergency department in psychiatry ?????
    Everyone knows that if you self harm you are more at risk of going too far but then perhaps nobody cares or can be bothered to ask?

    Mental health professionals are not psychic either;-)

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  • I agree with Marjorie, Mike's intolerance is perhaps much of the reason that depressed patients might go on to commit suicide. No, you are not expected to be a 'mental health nurse' or a 'psychologist', but it would be nice if you had some compassion.

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  • I admit 1 attendance in 12mths prior to suicide does seem to require some psychic skills. However:

    "You must recognise and work within the limits of your competence"
    "You must make a referral to another practitioner when it is in the best interests of someone in your care"

    Mike - yes, A&E personnel are not (generally) MH trained, but we have a Code of Conduct which answers the 'what are we expected to do' question. I've had some excellent A&E care where staff recognised this & were sensitive, but was put at life-threatening risk when my inability to speak was interpreted as non-cooperation and was sent home without MH assessment.
    The same applies to MH nurses re: areas outside their expertise. This week I heard from a patient who had is on a basal/bolus regime that he varies depending on his blood sugar. This was unfamiliar to the ward staff so, rather than check it out with diabetes staff, they withheld his insulin & threatened him with detention under MH Act when he protested this was dangerous.

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  • Some patients present themselves purely with Psychiatric problems such as depression, suicidal and so forth. Since there is no medical problem/ emergency involved we should therefore send the patient for Psychiatric evaluation. There is no need for them to be seen in the ER. This is the system here where I work, therefore no delay on the evaluation and pts receive appropriate treatment quicker. However, Psych pts who also present with minor medical emergencies should be treated first then send them for Psych Eval. This system works well for us not just for the pt but also in the ER in general. We use to see Psych pts in the ER and it was an average of 5 hours wait before they see a doctor for medical clearance. Then it was realized that Psychiatrists are also doctors who can do the same. Since then, any Psych pts without medical emergencies can go straigth for Psych Eval without being seen in the ER.

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  • The frequent attendance at A&E, presenting with minor physical complaints / DSH / parasuicidal behaviour, leading to an esculation and increase risk of suicide occuring, is not something new! This has been known (especially for those who have a diagnosis of PD) for a long time now.

    I would still like to know where the plan for an MH nursing and Childrens nurse 24/7 in all A&E departments are?!? Surely this interprofessional working and supporting each branch, can only lead to better quality of care?

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  • As a mental health nurse i just dont know what the f**k people who work in A+E are expected to do?
    The amount of patients that come into pysch units form A + E is a massive represntation of people on the ward....how unfair is this on A+E to be expected to spot those who are at risk?
    Before some smart arse pops up...yes there is psych liason in most A +E, nut its not like the telly on casualty where that fit RMN works shifts and does the same job as evryone else but somehow manages to sort out every person with a mental health problem in each episode.
    But most psych liason i know of runs 9-5 mon-fri, which im geussing isnt the time that A+E is at its busiest?
    Yeah they can make a refferal to crisis teams...but you'd think with word crisis that it would be a quick service...not a six-seven hour wait, where A +E staff are trying to keep an eye them so they dont go off the ward as well as deal with every other patient that walks in?
    if 1 in 3 people have mental illness...would it not be sensible to have a rmn on every shift in a + e , do they do these pead nurses? im not sure...but whats the point of publishing research like that to make peope feel shit about themselves about an area they aren't trained in...but expected to be experts in!!!

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  • I admit 1 attendance in 12mths prior to suicide does seem to require some psychic skills. However:

    "You must recognise and work within the limits of your competence"
    "You must make a referral to another practitioner when it is in the best interests of someone in your care"

    Mike - yes, A&E personnel are not (generally) MH trained, but we have a Code of Conduct which answers the 'what are we expected to do' question. I've had some excellent A&E care where staff recognised this & were sensitive, but was put at life-threatening risk when my inability to speak was interpreted as non-cooperation and was sent home without MH assessment.
    The same applies to MH nurses re: areas outside their expertise. This week I heard from a patient who had is on a basal/bolus regime that he varies depending on his blood sugar. This was unfamiliar to the ward staff so, rather than check it out with diabetes staff, they withheld his insulin & threatened him with detention under MH Act when he protested this was dangerous.

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  • Marjorie Lloyd

    err so when did being suicidal not become a medical emergency?

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  • Marjorie, what exactly about my comments is offensive?

    If a person presents with a medical problem and is obviously in need of MH input then of course they can be referred. If it is not immediately obvious, then that is far more difficult.

    As for your extremely short sighted comment 'err so when did being suicidal not become a medical emergency?' When a suicidal patient presents with something minor, yet shows absolutely no outward signs of MH problems or suicidal tendencies (not all do), and an RTA victim comes in at the same time as a patient with a severe stab wound. Are we supposed to second guess everything and spend time with the minor patient just in case he decides to commit suicide at some point in the future?

    Get real.

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