Repeat presentations to the emergency department for non‐fatal suicidal behaviour: Perceptions of patients

Abstract

Presentations to emergency departments (EDs) for non‐fatal suicidal behaviour (NFSB) are increasing in Australia and overseas. Our understanding of the factors contributing to this trend remains unclear. In this qualitative phenomenological study, we explored patient perceptions of their ED experience and the interventions provided. The study group comprised 10 adults who had had 3 or more presentations to the ED in a 12‐week period for NFSB. Individual interviews were conducted in person with participants and transcribed verbatim. Three broad themes emerged from analysis of the transcripts: ED – a safety net; 'treatment – what treatment!'; and maintaining ED dependence. The findings highlight a failure to understand the needs of those with NFSB and establish better ED treatment strategies and models of aftercare for this sub‐group of patients. The findings have implications for mental health nurses working with consumers in the ED and in broader case management roles.

“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

“…A 2013 study found that engaging with the help seeker as an individual deserving respect rather than simply treating the suicidal crisis facilitated help seekers’ positive self-evaluations and reducing feelings of hopelessness [ 26 ], and small acts of kindness in the ED can encourage help seekers to feel as though they are being considered more than just their presentation [ 27 ]. However, staff in EDs are under incredible pressure to provide high quality care with little resources [ 6 ], and as such, many staff focus on providing “treatment” for the condition rather than care for the individual in order to meet the demands of the busy ED setting.…”

“…The ED can be a challenging environment for help seekers as a place to seek care. 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 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].…”

“…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].…”

“…A large portion of help seekers are prompted to attend the ED by someone in their support network, be that family, friends, or a member of their health care team [6,8,9], and this person often accompanies them during this experience. The presence of support persons at the ED can help to mitigate the emotional distress experienced whilst in hospital and improve communication between help seekers and healthcare providers [10].…”