Hospitals' Response To Suicide Attempts: A Comprehensive Guide

Suicide is a serious global issue, and hospitals play a crucial role in addressing and managing suicide attempts. When an individual arrives at a hospital following a suicide attempt, the immediate priority of healthcare providers is to stabilize the patient's physical condition and ensure their safety. This involves providing emergency medical treatment and conducting a thorough physical examination. Once the patient's life is out of danger, the focus shifts to their mental health and emotional well-being. Mental health professionals employ various techniques, such as suicide assessments, to evaluate the patient's mental state, level of alertness, and orientation. These assessments help determine the patient's suicide risk and guide the next steps in their care. The patient may be admitted as an inpatient for continuous monitoring and treatment or discharged with a comprehensive care plan that includes outpatient visits and follow-up appointments with mental health specialists. Confidentiality and privacy are also crucial considerations, with hospitals being legally obligated to protect patients' health information under acts like the Health Insurance Portability and Accountability Act (HIPAA).

Hospitals must keep patient information confidential

When a person with suicidal thoughts or intentions arrives at a hospital, they are met by healthcare providers whose first priority is to save the patient's life. This involves stabilising the patient's physical condition and then providing emotional support. The patient's privacy must be respected at all times during this process, with only essential medical staff having access to their information. The patient's information may include details of their mental state, such as whether they have a plan or have had previous attempts or thoughts of suicide. This information is essential for healthcare providers to determine the best course of treatment and may include a mental health evaluation or suicide assessment.

After the patient's immediate needs are addressed, the hospital must determine the next steps in their care. This could involve transferring the patient to a higher level of care, such as a residential treatment program or a psychiatric hospital. It could also involve outpatient treatment, such as weekly therapy or psychiatry sessions. Inpatient hospitalization is meant to stabilise the patient and ensure their safety, rather than providing a cure. Again, the patient's privacy must be respected and protected throughout this process, regardless of the chosen course of treatment.

Following discharge from the hospital, close follow-up is crucial. This may include office visits, brief telephone calls, or other forms of support contact to help identify if further appointments or interventions are needed. All of this must be conducted with the utmost discretion, ensuring that the patient's information remains confidential and accessible only to those directly involved in their care. This confidentiality extends beyond the hospital stay and is a lifelong commitment to protecting the patient's privacy.

Physical examinations are critical for evaluation

When patients present to the emergency department following a suicide attempt, the first priority of healthcare providers is to save the patient's life and stabilise their physical condition. Once the patient is physically stable, the next priority is to stabilise them emotionally. This process involves a critical physical examination and evaluation by a mental health professional.

The physical examination is a critical element in the evaluation of patients who have attempted suicide. This is an area where primary care physicians can greatly contribute to patient care. Only 17% of psychiatrists routinely perform physical examinations on their inpatients, and the rate for outpatients is even lower. Up to 50% of patients with psychiatric complaints have been found to have underlying medical illnesses that may have contributed to their mental deterioration. Therefore, it is essential to identify and address any physical health issues during the examination.

During the initial encounter, the physician will collect observational data about the patient's mental status. They will ask simple, directed questions to establish the patient's level of alertness and orientation. For example, they may ask the patient to spell their name, identify the day of the week, or how they arrived at the hospital. These questions help assess the patient's cognitive function and awareness of their surroundings.

The physical examination also provides an opportunity to identify any injuries or medical complications resulting from the suicide attempt. For instance, in the case of a suicide attempt by hanging, it is crucial to assess for hypoxia-associated delirium and/or hippocampal damage/amnesia. A thorough physical examination can help detect these and other potential physical consequences, ensuring they are appropriately addressed in the patient's treatment plan.

Additionally, the physical examination can provide valuable insights into the patient's overall health and well-being. It can help identify any underlying medical conditions or substance abuse issues that may have contributed to the patient's mental health struggles. By addressing these physical health factors, the treatment team can develop a more comprehensive and effective care plan for the patient's recovery.

In conclusion, physical examinations are indeed critical for the evaluation and treatment of patients who have attempted suicide. They allow healthcare providers to stabilise the patient physically, identify any injuries or medical complications, and gain insights into the patient's mental and overall health. By combining this information with a mental health evaluation, a comprehensive treatment plan can be developed to address the patient's immediate and long-term needs.

Patients may be involuntarily hospitalised

In the case of suicide attempts, involuntary hospitalisation typically involves an initial emergency response phase, where the primary goal is to stabilise the patient's physical condition. This may include medical interventions to address any injuries or complications resulting from the attempt. Once the patient is physically stable, the focus shifts to emotional stabilisation, which may involve psychiatric evaluations, medication, and monitoring for behavioural changes. During this phase, mental health professionals will also assess the patient's suicide risk and determine the appropriate level of care needed, such as inpatient or outpatient treatment.

Inpatient hospitalization is a form of involuntary hospitalisation where the patient remains in a controlled environment 24/7, receiving constant care and supervision. This type of hospitalisation is typically reserved for individuals who are at a high risk of harming themselves or others and require intensive support. Inpatient facilities can vary, ranging from a floor in a general hospital to a freestanding psychiatric hospital, depending on the patient's needs and the availability of specialised care.

The decision to involuntarily hospitalise an individual is not taken lightly and is generally done in the best interest of the patient's safety and well-being. However, it is important to recognise that involuntary hospitalisation can be a traumatic experience for the patient, and the use of coercive measures, such as physical restraint or involuntary medication, can further complicate the individual's recovery. Therefore, involuntary hospitalisation should be accompanied by comprehensive discharge planning and ongoing outpatient care to ensure a smooth transition back to the community and reduce the risk of future suicide attempts.

In some cases, individuals may resist or attempt to escape from involuntary hospitalisation, particularly if they are agitated or fearful of hospitals and healthcare organisations. This can lead to confrontations with law enforcement and the use of force, as seen in the case of a patient who was subdued with a taser and sustained rib fractures during an escape attempt. Therefore, it is crucial for healthcare providers to carefully assess and manage the risks associated with involuntary hospitalisation, balancing the need for safety with the potential impact on the patient's mental health and recovery.

Emergency rooms can provide immediate support

During the assessment, the mental health professional will ask a series of questions to understand the patient's mental state and history. This may include inquiries about any plans or previous attempts, thoughts, hospitalizations, medications, and issues in their life. The evaluator will then decide on the appropriate level of care, which could range from outpatient treatment to inpatient hospitalization. Outpatient treatment involves weekly therapy, psychiatry, or group meetings, while inpatient hospitalization provides 24/7 acute care and support in a safe and stable environment.

In some cases, patients may be transferred to a higher level of care, such as a residential treatment program or a psychiatric hospital, if it is determined that they require additional support that cannot wait. The goal is to get the patient to a specialized facility that can best address their specific needs. It is important to note that hospitalization is not meant to provide a cure but rather to stabilize the patient and ensure their safety.

While in the emergency room, the healthcare providers' priorities are to save the patient's life, stabilize their physical condition, and provide emotional support. They also determine the patient's next steps, such as whether they need to be admitted to an inpatient facility or can be discharged home with a care plan that includes follow-up treatments. The emergency room staff's immediate support and comprehensive approach help address the patient's physical and mental health needs, ensuring their safety and providing a foundation for ongoing care.

Patients may be referred to psychiatric hospitals

When patients arrive at the hospital and inform health workers that they are experiencing suicidal thoughts, the hospital staff will call a mental health professional to determine the level of care required. This generally takes the form of a suicide assessment, which can include asking the patient to brainstorm reasons why they want to keep living. The patient's privacy must be protected at all times, with only medical staff directly involved in their care having access to their health information.

Following the assessment, the patient may be referred to a psychiatric hospital for further care. This could be a residential treatment program or a freestanding psychiatric hospital. The goal is to get the patient to a place that specializes in what they are going through and can provide the best care for their specific needs.

Inpatient hospitalization is meant to stabilize the patient and ensure their safety, rather than to "cure" them. It provides 24/7 acute care and support, with the patient spending both days and nights in the facility. During this time, patients may participate in various therapies, such as art therapy, music, and group therapy, and can benefit from social connections made during their stay.

Outpatient treatment is also an option for patients who are safe but experiencing suicidal thoughts. This typically involves weekly therapy, psychiatry, and/or group meetings. Partial hospitalization programs (PHP) are another form of outpatient treatment, where patients attend treatment during the day but return home at night. Intensive Outpatient Programs (IOP) are a variation of this, where patients attend treatment for 3-4 hours, 3-4 times a week.

Frequently asked questions