A Guideline for ED Staff
General Principles
- Patients who harm themselves have high rates of mental disorder, life stress and have an increased risk of further self-harm and suicide
- All patients presenting to the ED following self-harm should have a brief mental health assessment by ED staff and should be referred to a trained mental health professional for assessment at the earliest possible opportunity
Immediate Triage
- Patients should be triaged on arrival with the mental health triage scale (see laminate of scale on wall in Triage) in addition to the standard triage
- Staff should be aware of ongoing availability of means of repetition (e.g. tablets, weapon on person) and deal with this risk accordingly
ED Doctor assessment
In addition to necessary medical assessment and management, the ED Doctor should also consider the following:
- Is the patient physically fit to wait?
- Is there obvious severe emotional distress?
- Is the person actively suicidal?
- Is the person likely to wait for medical treatment and further mental health assessment?
- Does the patient have mental capacity?
When a patient following self-harm refuses treatment
- Remember that the Mental Health Act cannot be used in the ED to give treatment (medical or psychiatric) against a person’s wishes
- Consider whether or not the patient has the capacity to refuse treatment. If not, consider whether there is a situation of such urgent necessity that you proceed to treat the patient in their ‘best interests’ (ie under the common law)
- Do a brief mental health assessment. Consider whether there are grounds to apply for involuntary admission (under the Mental Health Act) to a psychiatric unit for treatment of a mental disorder
- Seek the advice of a senior colleague and/or contact CUH Psychiatry
When a patient following self-harm absconds from the ED
- Telephone the patient and ask him/her to come back for assessment / treatment
- Contact the patient’s next-of-kin
- Contact security to search the hospital area
- Consider contacting the Gardaí
- Complete an incident form
Referral by ED staff to Psychiatry
- All patients following self-harm should be referred to Psychiatry
- Patients over 18 years should be referred to the Self-Harm/Liaison Psychiatry CNS (8-4pm Monday-Sunday; VPN 65327/65324) or the On-Call Psychiatry SHO/Registrar (4-8am Monday – Sunday; VPN 67103)
- Patients under 18 years should be referred to Child & Adolescent Psychiatry (Tel: CUH switchboard)
- Please consider DSH (± refer to liaison psychiatry) in all cases of single occupant car crashes
- Please inform the liaison psychiatry team of cases of suicide who die in the ED or in the community but are brought to ED by the emergency services
Referral to CUH Social Work
- All patients <18 yrs following self-harm should be referred to the CUH Social Work in addition to Psychiatry
- All cases of adult presentation where Child Protection/Welfare concerns are identified
- All cases of adult self-harm presentation where Domestic Abuse / Elder Abuse is identified
Psychiatry Response to a Self-Harm Referral
- Psychiatry will respond to urgent referrals by telephone in the first instance
- his will be followed by an assessment on the same day, the timing and priority of which will depend on the level of urgency and on the day’s workload
- The outcome of the assessment and the management plan will be:
- recorded in the ED notes using a standardised assessment form
- discussed verbally with the ED staff
- discussed with the patient and/carer
- communicated to the patients GP