Nonwillingness to Return to the Emergency Department and Nonattendance of Follow-Up Care Arrangements Following an Initial Suicide-Related Presentation

Abstract

Abstract. Background: For people experiencing a suicidal crisis the emergency department (ED) is often the only option to find help. Aims: The aims of this study were (a) to identify predictors of patients' nonwillingness to return to the ED for help with a future suicidal crisis, and (b) whether nonwillingness to return was associated with follow-up appointment nonattendance. Method: This study utilized baseline data from the RESTORE online survey, and included 911 participants who had presented to an ED for suicidal crisis in the past 18 months, across participating local health districts in the Australian Capital Territory and New South Wales. Results: Patients who reported a more negative ED experience and longer triage wait times were less willing to return. Those who were less willing to return were also less likely to attend their follow-up appointment. Limitations: Due to the cross-sectional study design, causal inferences are not possible. Additionally, the self-report measures used are susceptible to recall bias. Conclusion: Patients' experience of service at EDs is a key indicator to drive improvement of patient outcomes for individuals experiencing a suicidal crisis.

“A Sustained, Productive, Constructive Relationship with Someone Who Can Help”—A Qualitative Exploration of the Experiences of Help Seekers and Support Persons Using the Emergency Department during a Suicide Crisis

“…Further to this, there was an overrepresentation of female participants, as well as limited demographics were collected from participants, and several at-risk demographic groups were not specifically targeted (such as LGBTIQ and Aboriginal and Torres Strait Islander participants), and as such is it difficult to apply this experience across all individuals engaging in emergency suicide crisis care. Nevertheless, these findings are consistent with other Australian studies [2,27,39,40] and it is vital that we honour the lived experience of help-seekers and support people in any service reform and design processes.…”

“…In addition, the recruitment method involved participants opting in to take part in an interview, which may have resulted in a biased sample where individuals who had a bad experience may be more likely to want to participate. For instance, some participants had experienced a series of failed attempts to receive help up until their presentation to the ED, which may have negatively coloured their recollections of the visit [2]. As there were only three dyads within the sample, the majority of the sample were unrelated people who attended as either help seeker or support person.…”

“…However, the majority of ED presentations during 2019 and 2020 were for physical concerns [1], so inevitably ED processes and environments have been designed with less focus on support for psychological distress. A negative ED experience for individuals in a suicide crisis presenting to EDs may reduce their willingness to return to the ED in future suicidal crises [2], which is concerning as people with a previous suicide attempt are at increased risk of dying by suicide-particularly in the first 12 months following an attempt [3]. Between 14-22% of individuals who present to hospitals with a previous suicide attempt will make another attempt within one year of presentation, of which 1.5% to 3% are fatal [4,5].…”

“…Help seekers have indicated that the chaotic and fast-paced environment of the ED, combined with long waiting times, is detrimental to their vulnerable state of mind [6,7]. Negative staff attitudes, such as low empathy, and a focus on physical injury have resulted in help seekers reporting negative ED experiences [2,[6][7][8]. Help seekers have also reported that their needs are not being met by the ED staff, with no treatment provided for their presentation and/or their presenting problem being dismissed [6,7].…”

Experiences of care for self-harm in the emergency department: the perspectives of patients, carers and practitioners

“…Unfortunately, the challenge of delivering high-quality care to people who present to the emergency department following selfharm is not a new problem, and the study by O'Keeffe and colleagues adds to a growing body of literature that documents the challenges experienced by both patients and staff. [5][6][7][8][9] Our own work with young people has shown that emergency departments are often found to be countertherapeutic, with staff appearing to lack both empathy and knowledge when treating young people who selfharm. 5 This is significant as young people (and in particular young females) make up the majority of emergency department presentations for self-harm and rates of presentation in this population appear to have increased during the COVID-19 pandemic.…”