Advance decisions to refuse treatment and suicidal behaviour in emergency care: ‘it's very much a step into the unknown’

Quinlivan, Leah; Nowland, Rebecca; Steeg, Sarah; Cooper, Jayne; Meehan, Declan; Godfrey, J M; Robertson, Duncan; Longson, Damien; Potokar, John; Davies, Rosalyn; Allen, Neil; Huxtable, Richard; Mackway‐Jones, Kevin; Hawton, Keith; Gunnell, David; Kapur, Navneet

doi:10.1192/bjo.2019.42

Cited by 4 publications

(1 citation statement)

References 30 publications

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“…Opinions on what should be done vary widely [103]. Even having advance directives can still involve ethical uncertainties [104][105][106][107]. There is debate on whether beneficence overrides patient autonomy in cases of suicide or grave disability [108,109].…”

Section: Ethicsmentioning

confidence: 99%

Managing a Suicidal or Gravely Disabled Patient on an Involuntary Psychiatric Hold and Who Has End-ofLife Orders: Key Factors to Consider in an Emergency Room Setting

Kalapatapu

2023

Curr Res Psychol Behav Sc

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Management of patients who have end-of-life orders may be complicated by the presence of an involuntary psychiatric hold for suicidality or grave disability. Decision-making factors that have been previously described include principles of medical ethics, laws and legal precedent, and examination of the motivations for end-of-life orders. However, management remains difficult, especially in time-limited settings such as the emergency room due to the wide-ranging existence of patient factors, individual ethics, and policies at governmental and hospital levels. We examined existing literature on the topic and created a structured conceptual model of key considerations for end-of-life issues during involuntary psychiatric holds in an emergency room setting, grouped into patient, involuntary psychiatric hold, system, and provider factors. These encompass the range of factors most likely to guide decision making on individual cases that emergency clinicians will face.

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Section: Ethicsmentioning

confidence: 99%

Managing a Suicidal or Gravely Disabled Patient on an Involuntary Psychiatric Hold and Who Has End-ofLife Orders: Key Factors to Consider in an Emergency Room Setting

Kalapatapu

2023

Curr Res Psychol Behav Sc

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Retrospective study on suicide attempts among psychiatric emergencies admitted to the emergency department of a Regional hospital in Turkey

Boğan,

Beki̇rcan,

Boğan

et al. 2024

Curr Psychol

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Introduction The aim of this study was to determine the sociodemographic characteristics of psychiatric emergencies presenting to emergency departments (ED), the provisional diagnoses and reasons for consultation by emergency physicians, and to determine the rate of suicide attempts among patients presenting to emergency departments for psychiatric emergencies. Methods The records of all patients aged 18 years and older admitted to the emergency department of the Department of Emergency Medicine, a tertiary hospital, with either a pre-existing psychiatric diagnosis or a new psychiatric provisional diagnosis made by emergency physicians between January 2020 and December 2023 were reviewed. Results According to the data obtained in the study, it was determined that the most common provisional diagnoses made by emergency physicians in psychiatric emergencies were suicide attempts (41.88%), agitation (21.94%), schizophrenia (8.44%), psychosis (7.91%) and manic attack (6.54%). It was found that 49.3% of psychiatric emergencies resulted in discharge and 25.5% resulted in hospitalisation. Among the provisional diagnoses, depression, mutism and sleep disorders were most commonly associated with refusal of treatment, while depression and suicide were the most common reasons for hospitalisation. Among psychiatric emergency patients who attempted suicide, medication, sharp objects and chemicals were the most common substances ingested. Discussion In this study, it was determined that a great portion of the emergency psychiatric cases admitted to the emergency department consisted of patients who attempted suicide. However, due to the crowdedness and fast pace of emergency departments, it is understood that in psychiatric emergencies, epidemiological profile data are missing in the files of the cases and detailed medical history cannot be obtained from the patients We think that recording better data of patient who admitted a psychiatric condition to the emergency department will provide better information about the patients in future visits and improve the care to be provided. Psychiatrists and psychiatric nurses recommend the implementation of emergency department-based rehabilitation programs for these patients.

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Patient safety and suicide prevention in mental health services: time for a new paradigm?

Quinlivan

Littlewood

Webb

et al. 2020

Journal of Mental Health

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Advance decisions to refuse treatment and suicidal behaviour in emergency care: ‘it's very much a step into the unknown’

Cited by 4 publications

References 30 publications

Managing a Suicidal or Gravely Disabled Patient on an Involuntary Psychiatric Hold and Who Has End-ofLife Orders: Key Factors to Consider in an Emergency Room Setting

Managing a Suicidal or Gravely Disabled Patient on an Involuntary Psychiatric Hold and Who Has End-ofLife Orders: Key Factors to Consider in an Emergency Room Setting

Retrospective study on suicide attempts among psychiatric emergencies admitted to the emergency department of a Regional hospital in Turkey

Patient safety and suicide prevention in mental health services: time for a new paradigm?

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