Hospital emergency poor experience for those in suicide distress

Too many people who present to emergency in suicide distress say they won’t go back even if they feel the same again, new study shows.

Too many people who present to emergency in suicide distress say they won’t go back even if they feel the same again, new study shows. Picture: istock

Almost half of those who visit a hospital emergency department in suicidal distress would be unwilling to return if they found themselves in the same critical state, a new study shows.

Long delays and incomplete assessments, symptomatic of a lack of resources, were two of the main reasons for the negative ­experience of EDs, the survey of 911 participants in NSW and the ACT found.

The 18-month study by mental health group The Black Dog Institute and published in the Crisis journal also found those who had a bad experience in an ED were also less likely to attend follow-up care.

“Frontline staff working in EDs across the country have ­repeatedly raised concerns over the level of care they’re able to provide to people in suicidal distress, due to the systems they ­operate within,” report co-author Fiona Shand, the Black Dog Institute’s head of suicide prevention research said.

Associate Professor Fiona Shand at The Black Dog Institute.

“They know what the problems are, and they want to do more, but the processes and lack of resourcing don’t allow them to spend adequate time with patients or work in the way they would like,” ­Associate Professor Shand said.

The study is one of the few to hear from so many with direct ­experience of suicidal distress. It found 43.5 per cent of those surveyed wouldn’t return to emergency even if in such distress.

Initial care of a person who presents to an ED is crucial, given this is the most likely place where they will seek help, and people who have made a previous suicide attempt have a 55.5 times higher risk of subsequent death by suicide than the general population.

Study participant, 38 year-old Canberra woman “Angela” (not her real name) said her ­experience of presenting to an ED in a suicidal state in 2019 only added to her high level of anxiety.

Angela said she was first taken to a “fast-track” area, initially ­assessed, then left for four hours while others came in and were discharged. “This added to my anxiety, made me feel that no one actually cared or took my issue ­seriously, and this made me become agitated,” she said.

“The ED is a really rough place to be in when you’re in crisis. Everything is so busy, there are bright lights and lots of machines beeping and mental stimulation. It was only when my situation worsened and I started yelling, crying and banging on the wall that they managed to find me a bed.”

With all acute mental health beds in the ED and the hospital full, Angela stayed overnight in a concealed cubicle of the ED. It had medical equipment and ­cables, and no one checked in on her all night, she said.

“I felt like I was just left alone, in a situation where I could easily have hurt myself or left the ED without anyone noticing.”

The struggle for EDs to handle people in suicide distress is an issue that warrants a structural ­rethink in the health system, ­according to John Bonning, president of the Australasian College for Emergency Medicine.

“It is unacceptably common for people in suicidal crisis to face disproportionately lengthy delays … after initial stabilisation by ED staff, with potentially life-threatening consequences,” Dr Bonning said. “Chronic under-investment in acute mental health beds is causing significant delays in ­patients who require it being ­admitted to hospital.”