National Survey Examines Emergency Department Management of Deliberate Self-Harm

How routinely do emergency room staff members properly provide help to individuals who present for self-harm? Do they appropriately assess patients who are experiencing current suicidal thoughts and offer to help develop individualized treatment plans?

These were just some of the critical questions asked in a recent study that examined the usage of evidence-based practices and follow-up care for emergency department (ED) patients who have self-injured.

According to the study, co-conducted by Penn’s School of Social Policy & Practice research associate professor Steven Marcus, PhD, approximately 500,000 patients annually in the United States enter EDs after presenting for self-harm.

Improving the emergency care of high risk patients is a key focus of national strategies to reduce the suicide rate, yet little is known about how emergency departments manage these patients, according to the study, which was recently published in JAMA Psychiatry. Researchers say the results offer the first national estimates of how frequently evidence-based management practices are used by EDs in the U.S.

To compile data, a national survey was conducted and mailed to a random sample of 665 ED nursing directors among 2,228 hospitals with five or more self-harm visits in the prior year. The survey assessed the availability of key mental health services that were provided to ED patients after an episode of deliberate self-harm; EDs were categorized according to teaching status, location, patient volume, and staffing.

“The new study highlights the gaps in the delivery of mental health care in emergency departments. Future work will need to identify effective strategies for incorporating evidence-based care into routine ED practice,” Marcus said. “Social workers represent a significant portion of the mental health workforce and so have an opportunity to play a key role in addressing this critical gap.”

The results showed that, overall, most EDs in the United States routinely assess patients who present with deliberate self-harm for suicidal thoughts and behaviors and access to lethal means, but relatively few routinely provided basic aspects of safety planning, such as creating individualized plans, helping patients to use internal coping strategies, or accessing available social supports.

“The next step will involve evaluating the extent to which safety planning in EDs protects high risk patients from future suicidal behavior,” Marcus said.