Psychiatric assessment in the emergency department: preliminary data from consumers about risk assessment following a suicide attempt or deliberate self-harm

Abstract

Suicide continues to be a world-wide problem. For every suicide there are many more suicide attempts and acts of deliberate self-harm. The Emergency Department (ED) of the public hospital is at the forefront of an increasing presentation rate of patients in the acute phase of mental illness or suicide risk, requiring specialised mental health risk assessment. Little is known of mental health patient views about their experience in the ED, yet consumer views are seen as an important factor in measuring the quality of psychiatric assessment and treatment. This paper sets out to examine consumer experiences of psychiatric assessment in the ED. Twenty participants, assessed in one of three public hospital EDs in Melbourne, Australia, following a suicide or deliberate self-harm (DSH) attempt, completed an anonymous online mixed method questionnaire. Participants reported an overall improvement in mood and expressed a positive view of the quality of service from the ED psychiatric team. Most helpful to participants was being listened to, not feeling judged, and having time to talk. What they found unhelpful was the lack of a private area for assessment, feeling 'labelled', and at times a lack of individual focus. What became apparent during this study was the difficulty in recruiting participants. A more direct-approach design to encouraging consumers to participate may increase response rates, however, privacy and power dynamics would pose an ethical challenge. Even though participation rate was low, the preliminary message from these ED consumers is still useful in formulating the beginnings of an important conversation with this group.

A Qualitative Account of Young People’s Experiences Seeking Care from Emergency Departments for Self-Harm

“…In one study, young participants reported feeling belittled and shamed, and some reported being more likely to engage in repeat self-harm after leaving the ED, due to these experiences [ 17 ]. Research on consumers’ experiences of self-harm care has predominantly focused on adults [ 18 , 19 , 20 , 21 ], and a recent systematic review revealed a substantial gap in knowledge of young consumers’ experiences and views on optimal treatment of self-harm in the ED [ 22 ]. This gap, and the notion that young people who self-harm are generally considered ‘vulnerable’ research participants [ 20 ], means that the acceptability, feasibility and safety of investigating young peoples’ experiences is undetermined.…”

Emergency department nurses’ perceptions of caring for patients with intentional self-poisoning: a qualitative study

“…16,17 Moreover, emergency department patients' experiences affect their decision to stay in the hospital and continue treatment, so that inappropriate experiences can lead to the recurrence of suicide in the patient. 17,18 Negative attitudes of nurses towards patients with intentional self-poisoning can also lead to inappropriate behaviors such as anger, lack of proper care provision, and punishment of patients. [16][17][18] The main concerns of patients with intentional self-poisoning are fear of being labeled by emergency department staff, the unwillingness of emergency department staff to care for them, and lack of respect for their privacy.…”

“…17,18 Negative attitudes of nurses towards patients with intentional self-poisoning can also lead to inappropriate behaviors such as anger, lack of proper care provision, and punishment of patients. [16][17][18] The main concerns of patients with intentional self-poisoning are fear of being labeled by emergency department staff, the unwillingness of emergency department staff to care for them, and lack of respect for their privacy. 18 Therefore, exploring nurses' perceptions toward caring for intentional self-poisoning patients can help improve the care process.…”

“…[16][17][18] The main concerns of patients with intentional self-poisoning are fear of being labeled by emergency department staff, the unwillingness of emergency department staff to care for them, and lack of respect for their privacy. 18 Therefore, exploring nurses' perceptions toward caring for intentional self-poisoning patients can help improve the care process. Although studies have been conducted on the perceptions of nurses and other members of the treatment team toward providing care for patients with intentional self-poisoning, these studies have been performed quantitatively and with a range of questions, and few in-depth studies have been done on nurses' perspectives.…”

Variation between hospitals in inpatient admission practices for self-harm patients and its impact on repeat presentation

“…As well as allowing the delivery of clinical care and facilitating psychosocial assessment in settings that do not provide round the clock access to psychiatric services, it has been hypothesised that admission to a hospital bed may have additional therapeutic benefits over and above those associated with treatment. In particular, hospital admission may provide a safe environment which aids recovery away from interpersonal conflict, and service users themselves have reported it as an important aspect of care [9, 10]. Yet despite its potential therapeutic benefits, more recent policy has focused on psychosocial assessment and moved away from an emphasis on hospital admission [11].…”