The International Handbook of Suicide Prevention: Research, Policy and Practice

By Rory C. O’Connor; Jane Pirkis | Go to book overview

22
Management of Suicidal Risk
in Emergency Departments
A Clinical Perspective

Simon Hatcher


Introduction

The importance of emergency departments as settings for suicide prevention efforts is evident from their inclusion in many suicide prevention programs such as the European Alliance Against Depression’s four-level approach (Hegerl, Althaus, Schmidtke, & Niklewski, 2006) and various national suicide prevention strategies. The suicide prevention strategy for England identifies the emergency department as a key site where people at high risk of suicide attend and where the risk of suicide may be reduced by a focus on “good communication and follow-up” (Department of Health, 2012). The U.S. National Strategy for Suicide Prevention (U.S. Department of Health and Human Services Office of the Surgeon General and National Action Alliance for Suicide Prevention, 2012) also explicitly names emergency departments in three of the plan’s objectives: (a) emphasizing continuity of care, safety; (b) collaboration between emergency departments and other health-care providers; and (c) standardized protocols for assessing suicidal people who present to emergency departments (U.S. Department of Health and Human Services Office of the Surgeon General and National Action Alliance for Suicide Prevention, 2012). This chapter describes the reasons why the emergency department is important in any suicide prevention strategy and why the traditional approach to risk management in suicidal patients is unhelpful. It also describes alternative approaches to patient management; outlines clinical skills appropriate for use with suicidal people in this setting; and ends with future directions for the management of suicidal risk in emergency departments.

In this chapter, I have defined self-harm as intentional self-poisoning or self-injury whether or not there is evidence that the act was intended to result in death. In the past, the term used was attempted suicide. However, people’s motives for harming themselves are complex, and assessing motivation or intent is often very difficult. Consequently, I have used the term self-harm, avoiding the word “deliberate” because many service users or consumers dislike its connotations. In the emergency department setting in highincome countries, about 80% of presentations for self-harm are medication overdoses,

The International Handbook of Suicide Prevention, Second Edition. Edited by Rory C. O’Connor and Jane Pirkis. © 2016 John Wiley & Sons, Ltd. Published 2016 by John Wiley & Sons, Ltd.

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