Hospital Alert: Unexpected Suicide Attempts0

A new alert from the Joint Commission warns that hospital emergency departments should be mindful of suicide attempts in patients with no history of psychiatric problems.

“A patient who attempts suicide in the emergency room or a hospital’s medical or surgical unit often has a different set of presenting complaints or a different diagnosis than a patient hospitalized in a psychiatric unit,” said Dr. Robert Wise, a psychiatrist and a Joint Commissioner medical adviser.

Of the 827 suicides reported to the Joint Commission since 1995, about a quarter of them occurred in non-psychiatric settings, like emergency departments. The methods were usually hanging, suffocation, intentional drug overdose and strangulation.

Dr. Wise noted that people with illnesses like cancer or dementia may begin to suicidal thoughts. “A patient diagnosed with cancer who is in intense, intractable pain may feel worn out and hopeless, even though they may not talk about the associated emotional issues of their disease,” Wise said. “Emergency room and hospital staffs tend to see medical illness — the high fever, chest pains that suggest serious medical problems. They may be less likely to think about how a cancer patient in unremitting pain feels when they are told the increase of pain is caused by the spread of the disease.”

Elana Premack Sandler, a prevention specialist with the Suicide Prevention Resource Center emphasized that this information should force health care practitioners “to think outside the box about their roles — to be equipped to know the warning signs of suicide and respond appropriately.”

According to the Joint Commission, those warnings include irritability, agitation, complaints of unrelenting pain, refusing visitors or medications and requesting early discharge. Dementia, chronic pain or illness, end-stage cancer, drug or alcohol intoxication may also heighten suicide risk. “These are signs that anyone — like friends, family or co-workers — can be aware of,” Sandler said.

Hospitals and Emergency Department staff should learn about suicide risk factors and warning signs, in addition to:

  • Doing suicide screenings in the ER.
  • Screening all patients for depression when they’re admitted to a hospital.
  • Checking anyone deemed to be at risk for items they could use to harm themselves.
  • Encouraging staff to call a mental health professional to evaluate patients believed to be at risk.

According to the National Institute of Mental Health, suicide is the 10th leading cause of death in the United States. [audio:|titles=Country Death Song]

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