"A Sustained, Productive, Constructive Relationship with Someone Who Can Help"-A Qualitative Exploration of the Experiences of Help Seekers and Support Persons Using the Emergency Department during a Suicide Crisis.

Demee Rheinberger,Lauren McGillivray,Alexandra Nicolopoulos,Myfanwy Maple,Diane Macdonald,Fiona Shand,Michelle Torok

doi:10.3390/ijerph181910262

Abstract

For Australians experiencing a suicide crisis, the emergency department (ED) is the recommended point of contact for intervention and to ensure personal safety. However, negative ED experiences can deter individuals from returning, thus impacting future suicide risk. In order to improve the ED environment for individuals in suicidal crisis, an in-depth understanding of this experience is needed. In-depth semi-structured interviews with 17 help seekers and 16 support persons were conducted. A grounded theory approach uncovered a core organising concept—all participants wanted a “a sustained, productive, constructive relationship with someone who can help” during the ED visit—which guided analysis. Thematic analysis resulted in two themes and four subthemes exploring the systemic and interpersonal aspects of the ED visit and the roadblocks and pathways to development of the relationship. Interpersonal factors included aspects of staff interaction and presence of a support person. Systemic factors related to aspects controlled by the physical space and internal policies and procedures and included aspects such as the chaotic environment, long waiting times, and access to staff. Overwhelmingly, there were more roadblocks than pathways reported by participants. Improving the ED environment, increasing staff training and encouraging the presence of support persons may help mitigate some of these roadblocks.

Highlights

For Australians experiencing a suicide crisis, both after a suicide attempt or when experiencing severe suicidal ideation, the emergency department (ED) is frequently the point of contact for intervention with particular regard to personal safety
A negative ED experience for individuals in a suicide crisis presenting to EDs may reduce their willingness to return to the ED in future suicidal crises [2], which is concerning as people with a previous suicide attempt are at increased risk of dying by suicide— in the first 12 months following an attempt [3]
All participants wanted access to “a sustained, productive, constructive relationship with someone who can help” and thematic analysis resulted in two themes and four sub-themes which detail how this was experienced (Table 1)

Summary

Introduction

The majority of ED presentations during 2019 and 2020 were for physical concerns [1], so inevitably ED processes and environments have been designed with less focus on support for psychological distress. A negative ED experience for individuals in a suicide crisis presenting to EDs may reduce their willingness to return to the ED in future suicidal crises [2], which is concerning as people with a previous suicide attempt are at increased risk of dying by suicide— in the first 12 months following an attempt [3]. Between 14–22% of individuals who present to hospitals with a previous suicide attempt will make another attempt within one year of presentation, of which 1.5% to 3% are fatal [4,5].

Objectives

Methods

Results

Discussion

Conclusion