Promoting Hope, Preventing Suicide

Research and advice on preventing teen and adult suicide

Suicide Prevention in the Emergency Room

How can future crises be averted?

I started working in a hospital last month, and all of a sudden, my eyes are wide open to the ways that hospitals and suicidal people intersect.

After a friend lost her sister to suicide, I spent a lot of time thinking about the way that intensive care units (ICUs) can help patients and families in the hospital following a suicide attempt.

But, lately, my radar screen has been getting lots of "blips" about kids and teens ending up in the emergency room for suicide attempts.

One of the reasons? Call a therapist. If she or he is unable to answer the phone, no doubt the voicemail message says that, if you're in crisis, you should go to the emergency room. Not, "Call the National Suicide Prevention Lifeline." Go to the place where people who slice their hand open cutting vegetables for dinner are bleeding on the floor. Go to the place where people go when they're having a heart attack. Not because those staff are adequately prepared to deal with your mental health crisis. But because it's the next best option. The only thing we've thought of. The way we've been doing things for years.

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It's true that doctors, nurses, and social workers in the emergency room are becoming better equipped to deal with mental health crises. It's also true that they've been dealing with them for years. But, it's most true that the emergency room isn't always, or even often, the best place for someone who's suicidal. Just the same, for kids and teens, for whom there are fewer specialized mental health resources available in general, the emergency room is sometimes the only option.

A recent study has shown just how important the emergency room can be in linking suicidal youth to services after they are discharged. A "family-based crisis-therapy session" designed to get patients and families to follow up with a community-based mental health service provider after discharge helps get young people into treatment. So do follow-up calls supporting that choice.

It's a first step, not a perfect solution. I think it helps illustrate just how complex it is to help someone in crisis, particularly in the context of shrinking financial and human resources in the mental health arena. The emergency room may be the first stop for someone in crisis, but it should by no means by the end of that person's journey.

I'd love to hear your thoughts on this issue. Have you or someone you know been in the ER in a mental health crisis? What lessons are there to learn?

Elana Premack Sandler, L.C.S.W., M.P.H., is a public health social worker specializing in violence and injury prevention and adolescent health promotion.

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