1
|
Feng YR, Valuri GM, Morgan VA, Preen DB, O’Leary CM, Crampin E, Waterreus A. Secondary mental health service utilisation following emergency department contact for suicidal behaviour: A systematic review. Aust N Z J Psychiatry 2023; 57:1208-1222. [PMID: 37161341 PMCID: PMC10466987 DOI: 10.1177/00048674231172116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Engagement with secondary mental health services after an emergency department presentation with suicidal behaviours may be an important strategy for reducing the risk of repeat attempts. Our aim was to examine secondary mental health service contact following a presentation to emergency department with suicidal behaviours. METHODS A systematic review of papers published between 2000 and 2020 was undertaken. This identified 56 papers relating to 47 primary studies. Data were extracted and summarised separately by age group: (1) young people, (2) older adults and (3) adults and studies with participants of 'all ages'. RESULTS Studies in young people (n = 13) showed, on average, 44.8% were referred and 33.7% had contact with secondary mental health services within 4 weeks of emergency department discharge. In comparison, in adult/all ages studies (n = 34), on average, 27.1% were referred to and 26.2% had mental health service contact within 4 weeks. Only three studies presented data on contact with mental health services for older adults, and proportions ranged from 49.0% to 86.0%. CONCLUSION This review highlights poor utilisation of secondary mental health service following emergency department presentation for suicidal behaviours, and further research is needed to identify the reasons for this. Crucially, this information could assist in the allocation of resources to facilitate the timely implementation of suicide prevention services.
Collapse
Affiliation(s)
- YR Feng
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - GM Valuri
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - DB Preen
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Colleen M O’Leary
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
- Office of the Chief Psychiatrist, Perth, WA, Australia
| | - E Crampin
- Office of the Chief Psychiatrist, Perth, WA, Australia
| | - A Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| |
Collapse
|
2
|
Wang J, Xie H, Holland KM, Sumner SA, Balaji AB, David-Ferdon CF, Crosby AE. Self-Directed Violence After Medical Emergency Department Visits Among Youth. Am J Prev Med 2019; 56:205-214. [PMID: 30573334 DOI: 10.1016/j.amepre.2018.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Identifying medical encounters that precede self-directed violence may allow for important prevention opportunities. This study examined the risk of self-directed violence after visiting the emergency department for a range of physical health conditions among youth. METHODS This retrospective cohort study used 2012-2013 statewide emergency department data from six states. Among patients aged 15-29 years, the exposure group included 2,192,322 emergency department visits for 16 selected conditions, coded by whether visits for those conditions were the first, second, or third or later visit for that condition. Emergency department visits for a minor infection served as the reference group (n=149,163). A Cox proportional hazard model was used to assess the risk of a self-directed violence event within 6 months for each condition. Analyses were conducted in 2017. RESULTS Overall, 8,489 (0.4%) of all patients visited the emergency department for self-directed violence over a 6-month period. Initial visits for epilepsy or seizures conveyed a markedly elevated hazard ratio for subsequent self-directed violence at 6.0 and 5.7, respectively (p<0.001). Initial visits for other conditions showed moderately elevated risk with hazard ratios primarily <2. Second visits for various pain symptoms, syncope, vomiting, or non-self-directed violence injury also had a 3- to 5-fold increase in hazard ratios for subsequent self-directed violence. Hazard ratios for third or later visit increased to 8.8 for back pain, 6.9 for headache, about 5 for abdominal pain, dental complaints, and non-self-directed violence injury (p<0.001). CONCLUSIONS Young people presenting to the emergency department for certain medical conditions are at an increased risk of subsequent self-directed violence. An awareness of these patterns may help guide screening efforts for suicide prevention in clinical settings.
Collapse
Affiliation(s)
- Jing Wang
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Hui Xie
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kristin M Holland
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven A Sumner
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexandra B Balaji
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Corinne F David-Ferdon
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexander E Crosby
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
3
|
Urban C, Arias SA, Segal DL, Camargo CA, Boudreaux ED, Miller I, Betz ME. Emergency Department patients with suicide risk: Differences in care by acute alcohol use. Gen Hosp Psychiatry 2018; 63:83-88. [PMID: 30293842 PMCID: PMC6433543 DOI: 10.1016/j.genhosppsych.2018.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/27/2018] [Accepted: 09/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To compare Emergency Department (ED) care of suicidal patients with and without documented acute alcohol use. METHODS Retrospective chart review of randomly sampled patient visits (n = 800; January 2014 to December 2015) at an urban ED with universal screening for suicide risk. Eligible visits were by adults (18+ years) who screened positive for suicide risk at the ED visit (i.e., suicidal ideation in past two weeks or suicide attempt in past six months). Analyses compared those with and without documentation of acute alcohol use. RESULTS Among these patients with suicide risk, 19% had documented acute alcohol use (versus 43% with no use and 38% without documentation); individuals with acute alcohol use were more often male and aged 35-59 years. Overall, 62% were evaluated by a mental health professional in the ED. Individuals with acute alcohol use were significantly less likely (vs those without use) to be evaluated by a mental health professional in the ED (odds ratio 0.49, 95%CI 0.28-0.87) after adjustment for age, recent suicide ideation, current suicide plan, self-harm as a chief complaint, contact with family, and ED disposition. CONCLUSIONS Although alcohol use can increase suicide risk, ED patients with acute use appear to receive less thorough suicide risk assessments.
Collapse
Affiliation(s)
- Chantel Urban
- Colorado School of Public Health; Aurora, Colorado, USA,Department of Emergency Medicine, University of Colorado School of Medicine; Aurora, Colorado, USA
| | - Sarah A. Arias
- Department of Psychiatry and Human Behavior, Brown University, Butler Hospital, Providence, RI, USA
| | - Daniel L. Segal
- Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs, CO, USA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Edwin D. Boudreaux
- Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ivan Miller
- Department of Psychiatry and Human Behavior, Brown University, Butler Hospital, Providence, RI, USA
| | - Marian E. Betz
- Department of Emergency Medicine, University of Colorado School of Medicine; Aurora, Colorado, USA
| |
Collapse
|
4
|
Hughes JL, Anderson NL, Wiblin JL, Asarnow JR. Predictors and Outcomes of Psychiatric Hospitalization in Youth Presenting to the Emergency Department with Suicidality. Suicide Life Threat Behav 2017; 47:193-204. [PMID: 27371938 DOI: 10.1111/sltb.12271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/24/2016] [Indexed: 11/29/2022]
Abstract
Youth suicide attempters presenting to the emergency department (ED) are frequently admitted to psychiatric inpatient hospitals, yet little is known about how clinicians decide which youths to admit versus discharge to outpatient care. We examine predictors of inpatient hospitalization and describe service use outcomes associated with hospitalization in 181 youths drawn from consecutive ED admissions for suicidality. Predictors of hospitalization include ED site, suicide plan, and parent report of problems. Hospitalization was associated with improved linkage to outpatient treatment and more intensive service use. Future research is needed to understand the best service delivery and treatments for these high-risk youth.
Collapse
Affiliation(s)
| | - Nicholas L Anderson
- Psychiatry and Biobehavioral, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jessica L Wiblin
- Psychiatry and Biobehavioral, University of California at Los Angeles, Los Angeles, CA, USA
| | - Joan R Asarnow
- Psychiatry and Biobehavioral, University of California at Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
5
|
Predictors of Future Suicide Attempts Among Individuals Referred to Psychiatric Services in the Emergency Department: A Longitudinal Study. J Nerv Ment Dis 2015; 203:507-13. [PMID: 26053262 DOI: 10.1097/nmd.0000000000000320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined which factors predict future suicide attempts (SAs) among people referred to psychiatric services in the emergency department (ED). It included consecutive adult (age >18 years) presentations (N = 6919) over a 3-year period to the two tertiary care hospitals in Manitoba, Canada. Medical professionals assessed each individual on 19 candidate risk factors. Stepwise logistic regression and receiver operating characteristic curves examined the association between the baseline variables and future SAs within the next 6 months. A total of 104 individuals re-presented to the ED with future SAs. Of the 19 baseline variables, only two independently accounted for the variance in future attempts. High-risk scores using this two-item model were associated with elevated odds of future SA (odds ratio, 3.22; 95% confidence interval, 1.62-6.42; p < 0.01), but this was tempered by a low positive predictive value. Further evaluation is required to determine if this two-item tool could help identify people requiring more comprehensive risk assessment referred to psychiatry in the ED.
Collapse
|
6
|
Sakinofsky I. Preventing suicide among inpatients. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:131-40. [PMID: 24881161 PMCID: PMC4079240 DOI: 10.1177/070674371405900304] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Inpatient suicide comprises a proportionately small but clinically important fraction of suicide. This study is intended as a qualitative analysis of the comprehensive English literature, highlighting what is known and what can be done to prevent inpatient suicide. METHOD A systematic search was conducted on the Cochrane Library, PubMed, Embase, Web of Knowledge, and a personal database for articles on cohort series, preferably controlled, of inpatient suicide (not deliberate self-harm or attempted suicide, unless they also dealt specifically with suicide data). RESULTS A qualitative discussion is presented, based on the findings of the literature searched. CONCLUSIONS The bulk of inpatient suicides actually occur not on the ward but off premises, when the patient was on leave or had absconded. Peaks occur shortly after admission and discharge. It is possible to reduce suicide risk on the ward by having a safe environment, optimizing patient visibility, supervising patients appropriately, careful assessment, awareness of and respect for suicide risk, good teamwork and communication, and adequate clinical treatment.
Collapse
|
7
|
Ronquillo L, Minassian A, Vilke GM, Wilson MP. Literature-based recommendations for suicide assessment in the emergency department: a review. J Emerg Med 2012; 43:836-42. [PMID: 23040403 DOI: 10.1016/j.jemermed.2012.08.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 08/15/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Suicidal ideation and attempted suicide are important presenting complaints in the Emergency Department (ED). The Joint Commission established a National Patient Safety Goal that requires screening for suicidal ideation to identify patients at risk for suicide. OBJECTIVES Given the emphasis on screening for suicidal ideation in the general hospital and ED, it is important for Emergency Physicians to be able to understand and perform suicide risk assessment. METHODS A review of literature was conducted using PubMed to determine important elements of suicide assessment in adults, ages 18 years and over, in the ED. Four typical ED cases are presented and the assessment of suicide risk in each case is discussed. RESULTS The goal of an ED evaluation is to appropriately determine which patients are at lowest suicide risk, and which patients are at higher or indeterminate risk such that psychiatry consultation is warranted while the patient is in the ED. Emergency clinicians should estimate this risk by taking into account baseline risk factors, such as previous suicide attempts, as well as acute risk factors, such as the presence of a suicide plan. CONCLUSION Although a brief screening of suicide risk in the ED does not have the sensitivity to accurately determine which patients are at highest risk of suicide after leaving the ED, patients at lowest risk may be identified. In these low-risk patients, psychiatric holds and real-time psychiatric consultation while in the ED may not be needed, facilitating more expeditious dispositions from the ED.
Collapse
Affiliation(s)
- Linda Ronquillo
- Alliant International University, California School of Professional Psychology, San Diego, California 92122, USA
| | | | | | | |
Collapse
|
8
|
Newton AS, Hamm MP, Bethell J, Rhodes AE, Bryan CJ, Tjosvold L, Ali S, Logue E, Manion IG. Pediatric suicide-related presentations: a systematic review of mental health care in the emergency department. Ann Emerg Med 2010; 56:649-59. [PMID: 20381916 PMCID: PMC3012108 DOI: 10.1016/j.annemergmed.2010.02.026] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 02/08/2010] [Accepted: 02/25/2010] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE We evaluate the effectiveness of interventions for pediatric patients with suicide-related emergency department (ED) visits. METHODS We searched of MEDLINE, EMBASE, the Cochrane Library, other electronic databases, references, and key journals/conference proceedings. We included experimental or quasiexperimental studies that evaluated psychosocial interventions for pediatric suicide-related ED visits. Inclusion screening, study selection, and methodological quality were assessed by 2 independent reviewers. One reviewer extracted the data and a second checked for completeness and accuracy. Consensus was reached by conference; disagreements were adjudicated by a third reviewer. We calculated odds ratios, relative risks (RRs), or mean differences for each study's primary outcome, with 95% confidence intervals (CIs). Meta-analysis was deferred because of clinical heterogeneity in intervention, patient population, and outcome. RESULTS We included 7 randomized controlled trials and 3 quasiexperimental studies, grouping and reviewing them according to intervention delivery: ED-based delivery (n=1), postdischarge delivery (n=6), and ED transition interventions (n=3). An ED-based discharge planning intervention increased the number of attended post-ED treatment sessions (mean difference=2.6 sessions; 95% CI 0.05 to 5.15 sessions). Of the 6 studies of postdischarge delivery interventions, 1 found increased adherence with service referral in patients who received community nurse home visits compared with simple placement referral at discharge (RR=1.28; 95% CI 1.06 to 1.56). The 3 ED transition intervention studies reported (1) reduced risk of subsequent suicide after brief ED intervention and postdischarge contact (RR=0.10; 95% CI 0.03 to 0.41); (2) reduced suicide-related hospitalizations when ED visits were followed up with interim, psychiatric care (RR=0.41; 95% CI 0.28 to 0.60); and (3) increased likelihood of treatment completion when psychiatric evaluation in the ED was followed by attendance of outpatient sessions with a parent (odds ratio=2.78; 95% CI 1.20 to 6.67). CONCLUSION Transition interventions appear most promising for reducing suicide-related outcomes and improving post-ED treatment adherence. Use of similar interventions and outcome measures in future studies would enhance the ability to derive strong recommendations from the clinical evidence in this area.
Collapse
Affiliation(s)
- Amanda S Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Cooper J, Murphy E, Jordan R, Mackway-Jones K. Communication between secondary and primary care following self-harm: are National Institute of Clinical Excellence (NICE) guidelines being met? Ann Gen Psychiatry 2008; 7:21. [PMID: 18947385 PMCID: PMC2584095 DOI: 10.1186/1744-859x-7-21] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Accepted: 10/23/2008] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Most patients contact their general practitioner (GP) following presentation to an Emergency Department (ED) after a self-harm incident, and strategies to help GPs manage these patients include efficient communication between services. The aim of this study was to assess the standard of documentation and communication to primary care from secondary care as recommended by the National Institute of Clinical Excellence (NICE) guidelines on the short-term management of people who self-harm. METHODS An audit of medical records (ED and Psychiatric) on people aged 16 years and over who had presented to the ED following self-harm, benchmarked according to government guidelines, was performed. Data were collected over a 4-week period at a general teaching hospital. RESULTS We collected data on 93 consecutive episodes of self-harm; 62% of episodes were communicated to primary care, 58% of these communications were within 24 h and most within 3 days. Patient identifying details and follow-up arrangements were specified in most cases. Communication via psychiatric staff was most detailed. ED clinicians provided few communications and were of limited content. Communication with the patient's GP was not made in half of those cases seen by a mental health specialist. CONCLUSION Government guidelines are only partially being met. Reliance on communication by ED staff would leave a substantial proportion of patients discharged from the ED with no or minimal communication to primary care. Psychiatric services need to improve the rate of communication to the patient's GP following assessment A national sample of National Health Service (NHS) trusts would establish if this is a problem elsewhere.
Collapse
Affiliation(s)
- Jayne Cooper
- Community Based Medicine, Department of Psychiatry, University of Manchester, UK.
| | | | | | | |
Collapse
|
10
|
Cooper J, Kapur N, Dunning J, Guthrie E, Appleby L, Mackway-Jones K. A Clinical Tool for Assessing Risk After Self-Harm. Ann Emerg Med 2006; 48:459-66. [PMID: 16997684 DOI: 10.1016/j.annemergmed.2006.07.944] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Revised: 07/07/2006] [Accepted: 07/25/2006] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE Our aim is to develop a risk-stratification model for use by emergency department (ED) clinical staff in the assessment of patients attending with self-harm. METHODS Participants were patients who attended 5 EDs in Manchester and Salford, England, after self-harm between September 1, 1997, and February 28, 2001. Social, demographic, and clinical information was collected for each patient at each attendance. With data from the Manchester and Salford Self-Harm Project, a clinical decision rule was derived by using recursive partitioning to discriminate between patients at higher and lower risk of repetition or subsequent suicide occurring within 6 months. Data from 3 EDs were used for the derivation set. The model was validated with data from the remaining 2 EDs. RESULTS Data for 9,086 patients who presented with self-harm were collected during this study period, including 17% that reattended within 6 months and 22 patients who died by suicide within 6 months. A 4-question rule, with a sensitivity of 94% (92.1-95.0% [95% confidence interval]) and specificity of 25% (24.2-26.5% [95% confidence interval]), was derived to identify patients at higher risk of repetition or suicide. CONCLUSION Application of this simple, highly sensitive rule may facilitate assessment in the ED and help to focus psychiatric resources on patients at higher risk.
Collapse
Affiliation(s)
- Jayne Cooper
- Centre for Suicide Prevention, University of Manchester, Manchester, England.
| | | | | | | | | | | |
Collapse
|
11
|
Drew BL, Jones SL, Meldon SW, Varley JD. Emergency department visits for suicidality in three hospitals. Arch Psychiatr Nurs 2006; 20:117-25. [PMID: 16716855 DOI: 10.1016/j.apnu.2005.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Revised: 10/17/2005] [Accepted: 11/15/2005] [Indexed: 11/18/2022]
Abstract
The purposes of this study were to describe suicidal persons who come to the emergency department (ED) and to examine the relationship between clinical and health service characteristics and decisions regarding post-ED care. Data were collected from three hospital EDs by means of a retrospective review of records. During the 1-month study period, 163 ED visits were for suicidal ideation (f = 110) or behavior (f = 53). The mean age of the patients was 36.5 years (range = 5-87 years); 51% were female patients. Clinical decisions about post-ED care tended to be cautious, regardless of a patient's level of suicidality, with 71% of patients either transferred for psychiatric evaluation or admitted to the psychiatric unit. Emergency department staff tended to be slightly more conservative than mental health professionals, but the difference in their decisions about disposition was not significant.
Collapse
Affiliation(s)
- Barbara L Drew
- College of Nursing, Kent State University, Kent, OH 44242, USA.
| | | | | | | |
Collapse
|
12
|
Pompili M, Girardi P, Ruberto A, Kotzalidis GD, Tatarelli R. Emergency staff reactions to suicidal and self-harming patients. Eur J Emerg Med 2005; 12:169-78. [PMID: 16034262 DOI: 10.1097/00063110-200508000-00005] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Staff in the emergency departments of hospitals are reported as being negative or ambivalent toward suicidal or self-harming individuals. According to the literature, these patients are subjected to stigmatization and lack of empathy. This phenomenon has been linked to a decreased quality of care offered to these individuals and to missing an important opportunity to prevent further suicidal behavior or repetition of deliberate self-harm. Also, protocols, proper guidelines and education for the emergency staff call for a revision and an implementation. In this paper, evidence suggesting staff attitudes toward suicidal and self-harming patients is reviewed. An overview of related issues such as clinical judgment, the use of scales and nurses' role is also included in this report.
Collapse
Affiliation(s)
- Maurizio Pompili
- Department of Psychiatry, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy.
| | | | | | | | | |
Collapse
|