Management of Patients with Suicide Risk in Emergency Medicine
1Founder, GEMPA, Georgia
Suicide is 10th leading cause of mortality in US and worldwide. According the WHO, someone kills himself in every 30 minutes. Overall suicide attempts occur even more frequently. Sometime patient is making statements of suicide to attract someone’s attention though it Is difficult to determine which patient is high risk suicidal. Therefor Joint Commission standard (National Patient Safety Goals (NPSG) 15.01.01 2010) calls for universal screening for risk of suicide and in case of positive screening to make plan for further management.
Detection, prediction and management of suicidal patients are related to the different aspects of ethic. Patients have rights and medical staff should respect them. rights to be treated with dignity in the environment of trust. The staff should support the autonomy of the patients. All these might be achieved with the collaborative and transparent approaches. To give the feedback and inform them what will be happening, use informed consent and ask the patients about their expectations.
Involvement of family/support people in management plan is important. If patient refuses involvement of others, staff should act according the interest of keeping patient safe. They should maintain confidentiality according the code of conduct and same time assess safety aspects.
The “best practice” techniques should be used for suicide risk assessment in order to protect the patients from harm. This might be expressed in following approaches: to have the relevant risk assessment methodology (for example: SAD PERSON scoring system) not to underestimate the risk and to enhance the evidence-based decision-making process. Several aspects should be mentioned in this regard:
- Ask the question separately to keep the privacy of patient. It is best to use the finesse instead of forcing the situation. Gain the patient trust
- Ask the patient about the suicidal thought, there is no evidence that it worsens the suicidal risk in those who already have it. Take in mind cultural aspects as well.
- Keep patient safe in the department, use the sedation medicine if necessary, use the restraints only as the last resort just in emergency situation, keep the seclusion room in ED in appropriate condition, make decision about the isolation of patient based on safety interest and perform the close monitoring. Search and remove the weapons and other lethal means but behaving with dignity.
- Have a specially trained personal in ED and mental health specialists
- Make decision regarding the disposition based the risk assessment in collaboration the family members/supportive people. Take in account the social economical aspects and safety of people around. Follow the formal recommendation how to discharge the patient safely and give the clear recommendation to him and attending persons. Involve the patients in his own treatment.
The ethical issues of suicide patient management should be considered in a cultural context and local regulations, especially in the countries like Georgian, where emergency medicine is just started. Processes related to patients care including the suicide patients is not fully standardized yet. Many have done but many still need to be done.