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Psychosocial Assessment in the Emergency Department

The Experiences of People Presenting With Self-Harm and Suicidality

Published Online:May 27, 2021https://doi.org/10.1027/0227-5910/a000786

Abstract

Abstract.Background: In the United Kingdom, suicide risk is assessed in the emergency department (ED) in a face-to-face assessment with psychiatric liaison practitioners. This study aimed to explore patient experiences of psychosocial assessment after presenting with self-harm/suicidality. Method: A total of 28 patients were interviewed within 2 weeks of ED attendance for self-harm/suicidality. Interviews were transcribed and analyzed using inductive thematic analysis. Results: People described two different experiences. A therapeutic interaction was about the “person” and made people feel their life mattered and instilled hope for the future. This was characterized by: unscripted conversation; warmth promoting disclosure; psychological exploration of feelings; validation of distress; and a coproduced care plan. A formulaic assessment was about the “risk” and made people feel their life did not matter and hopeless about the future. This was characterized by: feeling judged and not worthy of help; a focus on risk and form filling; a trivial treatment plan; and loss of trust in services. Limitations: Our study comprised a single ED and used a non-diverse sample. Conclusion: Psychosocial assessment in the ED impacts on hope for people in crisis. A focus on therapeutic communication that is about the person, as well as the risk, improves patient experience, decreases distress, and instills hope that life is worth living.

References

  • Benedetti, F., Lanotte, M., Lopiano, L., & Colloca, L. (2007). When words are painful: Unraveling the mechanisms of the nocebo effect. Neuroscience, 147(2), 260–271. 10.1016/j.neuroscience.2007.02.020 First citation in articleCrossref Medline, Google Scholar

  • Berglund, S., Åström, S., & Lindgren, B.-M. (2016). Patients' experiences after attempted suicide: A literature review. Issues in Mental Health Nursing, 37(10), 715–726. 10.1080/01612840.2016.1192706 First citation in articleCrossref Medline, Google Scholar

  • Bhui, K. S. (2016). Smuggling compassion into care: Is the NHS destined for system D? Australian & New Zealand Journal of Psychiatry, 50(7), 611–612. 10.1177/0004867416654577 First citation in articleCrossref Medline, Google Scholar

  • Bolger, S., O'Connor, P., Malone, K., & Fitzpatrick, C. (2004). Adolescents with suicidal behaviour: Attendance at A&E and six month follow-up. Irish Institute of Psychological Medicine, 21(3), 78–84. 10.1017/S0790966700008405 First citation in articleCrossref Medline, Google Scholar

  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. 10.1191/1478088706qp063oa First citation in articleCrossref, Google Scholar

  • Chan, M. K. Y., Bhatti, H., Meader, N., Stockton, S., Evans, J., O'Connor, R. C., Kapur, N., & Kendall, T. (2016). Predicting suicide following self-harm: Systematic review of risk factors and risk scales. British Journal of Psychiatry, 209(4), 277–283. 10.1192/bjp.bp.115.170050 First citation in articleCrossref Medline, Google Scholar

  • Clarke, D. E., Dusome, D., & Hughes, L. (2007). Emergency department from the mental health client's perspective. International Journal of Mental Health Nursing, 16(2), 126–131. 10.1111/j.1447-0349.2007.00455.x First citation in articleCrossref Medline, Google Scholar

  • Crandall, C., Fullerton-Gleason, L., Aguero, R., & LaValley, J. (2006). Subsequent suicide mortality among emergency department patients seen for suicidal behavior. Academic Emergency Medicine, 13(4), 435–442. 10.1197/j.aem.2005.11.072 First citation in articleCrossref Medline, Google Scholar

  • Cully, G., Leahy, D., Shiely, F., & Arensman, E. (2020). Patients' experiences of engagement with healthcare services following a high-risk self-harm presentation to a hospital emergency department: A mixed methods study. Archives of Suicide Research: Advance Online Publication, 1–21. 10.1080/13811118.2020.1779153 First citation in articleCrossref, Google Scholar

  • Da Cruz, D., Pearson, A., Saini, P., Miles, C., While, D., Swinson, N., Williams, A., Shaw, J., Appleby, L., & Kapur, N. (2011). Emergency department contact prior to suicide in mental health patients. Emergency Medicine Journal, 28(6), 467–471. 10.1136/emj.2009.081869 First citation in articleCrossref Medline, Google Scholar

  • Gunnell, D., Appleby, L., Arensman, E., Hawton, K., John, A., Kapur, N., Khan, M., O'Connor, R. C., Pirkis, J., Appleby, L., Arensman, E., Caine, E. D., Chan, L. F., Chang, S.-S., Chen, Y.-Y., Christensen, H., Dandona, R., Eddleston, M., Erlangsen, A., … Yip, P. S. & the COVID-19 Suicide Prevention Research Collaboration. (2020). Suicide risk and prevention during the COVID-19 pandemic. The Lancet Psychiatry, 7(6), 468–471. 10.1016/S2215-0366(20)30171-1 First citation in articleCrossref Medline, Google Scholar

  • House, A., & Owens, D. (2020). General hospital services in the UK for adults presenting after self-harm: Little evidence of progress in the past 25 years. British Journal of Psychiatry, 217(6), 661–662. 10.1192/bjp.2020.85 First citation in articleCrossref Medline, Google Scholar

  • Howick, J., Moscrop, A., Mebius, A., Fanshawe, T. R., Lewith, G., Bishop, F. L., Mistiaen, P., Roberts, N. W., Dieninytė, E., Hu, X.-Y., Aveyard, P., & Onakpoya, I. J. (2018). Effects of empathic and positive communication in healthcare consultations: A systematic review and meta-analysis. Journal of the Royal Society of Medicine, 111(7), 240–252. 10.1177/0141076818769477 First citation in articleCrossref Medline, Google Scholar

  • Hunter, C., Chantler, K., Kapur, N., & Cooper, J. (2013). Service user perspectives on psychosocial assessment following self-harm and its impact on further help-seeking: A qualitative study. Journal of Affective Disorders, 145(3), 315–323. 10.1016/j.jad.2012.08.009 First citation in articleCrossref Medline, Google Scholar

  • Kapur, N., Murphy, E., Cooper, J., Bergen, H., Hawton, K., Simkin, S., Casey, D., Horrocks, J., Lilley, R., Noble, R., & Owens, D. (2008). Psychosocial assessment following self-harm: Results from the multi-centre monitoring of self-harm project. Journal of Affective Disorders, 106(3), 285–293. 10.1016/j.jad.2007.07.010 First citation in articleCrossref Medline, Google Scholar

  • MacDonald, S., Sampson, C., Turley, R., Biddle, L., Ring, N., Begley, R., & Evans, R. (2020). Patients' experiences of emergency hospital care following self-harm: Systematic review and thematic synthesis of qualitative research. Qualitative Health Research, 30(3), 471–485. 10.1177/1049732319886566 First citation in articleCrossref Medline, Google Scholar

  • Morphet, J., Innes, K., Munro, I., O'Brien, A., Gaskin, C. J., Reed, F., & Kudinoff, T. (2012). Managing people with mental health presentations in emergency departments—A service exploration of the issues surrounding responsiveness from a mental health care consumer and carer perspective. Australasian Emergency Nursing Journal, 15(3), 148–155. 10.1016/j.aenj.2012.05.003 First citation in articleCrossref Medline, Google Scholar

  • National Institute for Clinical Excellence (2013). Self-harm: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. https://www.nice.org.uk/guidance/qs34 First citation in articleGoogle Scholar

  • Office for National Statistics (2019). Suicides in the UK: 2018 registrations. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2018registrations#main-points First citation in articleGoogle Scholar

  • Owens, C., Hansford, L., Sharkey, S., & Ford, T. (2016). Needs and fears of young people presenting at accident and emergency department following an act of self-harm: Secondary analysis of qualitative data. British Journal of Psychiatry, 208(3), 286–291. 10.1192/bjp.bp.113.141242 First citation in articleCrossref Medline, Google Scholar

  • Philippot, P., Feldman, R. S., & Coats, E. J. (2003). The role of nonverbal behavior in clinical settings: Introduction and overview. In P. PhilippotR. S. FeldmanE. J. Coats (Eds.), Series in affective science. Nonverbal behavior in clinical settings (pp. 3–13). Oxford University Press. First citation in articleCrossref, Google Scholar

  • Pompili, M., Girardi, P., Ruberto, A., Kotzalidis, G. D., & Tatarelli, R. (2005). Emergency staff reactions to suicidal and self-harming patients. European Journal of Emergency Medicine, 12(4), 169–178. 10.1097/00063110-200508000-00005 First citation in articleCrossref Medline, Google Scholar

  • Priebe, S., Conneely, M., McCabe, R., & Bird, V. (2020). What can clinicians do to improve outcomes across psychiatric treatments: A conceptual review of non-specific components. Epidemiology and Psychiatric Sciences, 29, e48. 10.1017/S2045796019000428 First citation in articleCrossref, Google Scholar

  • Taylor, T. L., Hawton, K., Fortune, S., & Kapur, N. (2009). Attitudes towards clinical services among people who self-harm: Systematic review. British Journal of Psychiatry, 194(2), 104–110. 10.1192/bjp.bp.107.046425 First citation in articleCrossref Medline, Google Scholar

  • Thomas, K. C., Owino, H., Ansari, S., Adams, L., Cyr, J. M., Gaynes, B. N., & Glickman, S. W. (2018). Patient-centered values and experiences with emergency department and mental health crisis care. Administration and Policy in Mental Health, 45(4), 611–622. 10.1007/s10488-018-0849-y First citation in articleCrossref Medline, Google Scholar

  • Vatne, M., & Nåden, D. (2014). Patients' experiences in the aftermath of suicidal crises. Nursing Ethics, 21(2), 163–175. 10.1177/0969733013493218 First citation in articleCrossref Medline, Google Scholar