Emergency care may be failing to spot suicidal patients
27 Jul 2010
Emergency care may be failing to spot patients who go on to die by suicide – many of whom use these services in the year leading up to their death, suggests a small University of Manchester study.
Around 5,000 people kill themselves in England and Wales each year and previous research has indicated that the emergency department might be well-placed to pick up patients vulnerable to suicide.
The researchers reviewed emergency department hospital records in the North West of England for 286 people who died by suicide between 2003 and 2005 and had been in contact with mental-health services within 12 months of their death. In all, emergency department data from 38 hospitals were assessed.
The suicides were identified from information submitted to the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness at The University of Manchester.
The analysis, published in Emergency Medicine Journal, showed that more than four out of 10, 124 of the 286 who had died by suicide had sought treatment at emergency care departments at least once in the year leading up to their death.
And of these 124, 35 (28%) had visited emergency care facilities more than three times in the last year of their lives.
These ‘frequent attenders’ died by suicide significantly sooner after their last visit to emergency care than those who attended less frequently.
More than half (55%) of those who took their own lives were unemployed or on long-term sick leave at the time of their death. The average age of the sample was 47, ranging from 19 to 95. There were twice as many men as women.
One in five cases had a primary diagnosis of schizophrenia and other delusional disorders; almost half (48%) had affective disorders, such as bipolar disorder and depression. Around one in 10 (9%) were dependent on alcohol and 3% were diagnosed as drug dependent.
The ‘frequent attenders’ were significantly more likely to have a history of self-harm and alcohol misuse. They were also more likely to be unemployed and to have sought help for psychological reasons, including self-harm.
Best practice guidance recommends that self-harming patients who seek emergency care should be given a psychosocial assessment but the researchers found little documented evidence to suggest this was happening. However, this may not have reflected a lack of care, since many patients were admitted to hospital for additional treatment.
“Although psychiatric services clearly have a prominent role in preventing suicide in mental health patients, emergency care departments may represent an important additional setting for suicide prevention,” said Research Assistant Damian Da Cruz.
“Frequent attenders may represent a high-risk group, and this should be recognised by emergency services. Closer liaison with general practitioners and mental-health services to ensure appropriate and consistent management of these often complex cases may be of benefit.”
Notes for editors
A copy of the paper, ‘Emergency department contact prior to suicide in mental health patients’ [Online First Emerg Med J 2010; doi 10.1136/wmj.2009.081869], is available on request.
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