Emergency department contact prior to suicide in mental health patients

Damian Da Cruz · Pooja Saini · Caroline Miles · David While · Nicola Swinson · Alyson Williams +3 more

146 citations0/0 files storedEmergency Medicine Journal

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Suicide and Self-Harm Studies Psychiatric care and mental health services Emergency and Acute Care Studies

Abstract

OBJECTIVES: To describe attendance at emergency departments (EDs) in the year prior to suicide for a sample of mental health patients. To examine the characteristics of those who attended (particularly those who attended frequently) prior to suicide. DESIGN: Case review of ED records for 286 individuals who died within 12 months of mental health contact in North West England (2003-2005). METHOD: Cases identified through the National Confidential Inquiry into Suicide were checked against regional EDs to establish attendance in the year prior to death. Records were examined to establish the number of attendances, reason for the final, non-fatal attendance, treatment offered and outcome. RESULTS: One hundred and twenty-four (43%) individuals had attended the ED at least once in the year prior to their death, and of these, 35 (28%) had attended the ED on more than three occasions. These frequent attenders died by suicide significantly sooner after their final, non-fatal attendance than other attenders. A clinical history of alcohol misuse was also associated with early death following ED attendance. CONCLUSIONS: Over 40% of our clinical sample attended an ED in the year prior to death, and some individuals attended particularly frequently. EDs may therefore represent an important additional setting for suicide prevention in mental health patients. The majority of attendances prior to suicide were for self-harm or to request psychiatric help. Clinicians should be alert to the risk associated with such presentations and to the possible association between frequent attendance and suicide.

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References

2005Suicide Prevention Strategies 1997Suicide as an outcome for mental disorders 2003The National Suicide Prevention Strategy for England 1994Suicide as an Outcome for Medical Disorders 2003Attendance at the accident and emergency department in the year before suicide: Retrospective study 2009Attitudes towards clinical services among people who self-harm: systematic review 2006Suicide in mental health in-patients and within 3 months of discharge 1999Safer Services: Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness

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