Bibliography - Trauma, Crisis Services, and Suicide

Resources Related to Improving Treatment of Behavioral Health Patients in Emergency Department Settings
* Resources that are not specific to behavioral health are preceded by an asterisk.

Agency for Health Care Research and Quality (12/19/2012). Psychological First Aid: Field Operations Guide, 2nd Edition. (Quality Tool). Available at: http://ptsd.va.gov/professional/manuals/psych-first-aid.asp

  • This guide is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism, to reduce initial distress and to foster short- and long-term adaptive functioning.

Center for Public Representation. Trauma Informed Care: Implementation in Emergency Departments (2/13/2006). Available at: http://www.centerforpublicrep.org/litigation-and-major-cases/emergency-rooms

  • A power point presentation summarizing best practices for trauma informed care in hospital emergency departments, including the professional, regulatory, and legal standards that apply.

Allen MH, Forster P, Zealberg J, Currier G. Report and Recommendations Regarding Psychiatric Emergency and Crisis Services: A Review and Model Program Descriptions. American Psychiatric Association Task Force on Psychiatric Emergency Services; August 2002. Available at: http://emergencypsychiatry.org/data/tfr200201.pdf

  • This report provides a detailed discussion of different models for providing psychiatric emergency and crisis services, including the provision of such services in the medical emergency department (this discussion begins on page 20).

American Psychiatric Association (APA, 2002). Report and Recommendations Regarding Psychiatric Emergency and Crisis Services. Available at http://www.emergencypsychiatry.org/data/tfr200201.pdf

  • This report provides a review of literature related to psychiatric emergency services and describes several models for providing such services.

American Psychiatric Nurses Association. The APNA has webinars for psychiatric nurses working in the emergency department setting available at: http://www.apna.org/i4a/pages/index.cfm?pageID=4282

Webinars include:

  • “Psychiatric Emergencies”
  • “Effective Reduction of Restraint and Seclusion in the Psychiatric Emergency Department while Maintaining a Safe Milieu”
  • “Emergency Room Care of the Psychiatric Patient: Selected Topics”
  • “Psychiatric Advanced Practice Registered Nurse Role in Alcohol and Substance Abuse Evaluation in the Emergency Department”

Antai-Otong, D. (2001). Psychiatric Emergencies, 2nd Edition. PESI Healthcare, LLC. Eau Claire, WS
Available at: http://www.pesi.com/bookstore/Psychiatric_Emergencies__2nd_Edition-details.aspx

  • This updated handbook is intended to help health care providers in a variety of settings to recognize and assess psychiatric problems promptly and accurately, intervene safely, and initiate appropriate treatment.

New York State Office of Mental Health. Annual Report to the Governor and Legislature of New York State on Comprehensive Psychiatric Emergency Programs; 2010. Available at: http://www.omh.ny.gov/omhweb/statistics/cpep_annual_report/2010.pdf

  • This report provides an overview of a comprehensive, coordinated emergency service system designed to provide a systematic response to psychiatric emergencies in urban areas. CPEP objectives include providing timely triage, assessments, and interventions; controlling inpatient admissions; providing crisis intervention in the community; and providing linkages to other services.

Persis, M. (2007) Psychiatric Emergencies: Caring for People in Crisis. Wild Iris Medical Education, Inc.
Available at: http://www.wildirismedicaleducation.com/courses/358/index_nceu.html

  • This is a nursing CEU course intended to provide healthcare professionals with information about psychiatric emergencies from the perspective of crisis intervention, including assessment, diagnosis, planning, intervention, and evaluation of people in crisis related to mood, anxiety, anger, substance use, and major mental illnesses.

Substance Abuse and Mental Health Services Administration. Practice Guidelines: Core Elements for Responding to Mental Health Crises. HHS Pub. No. SMA-09-4427. Rockville, MD: Center for Mental Health Services, 2009.
Available at: http://www.store.samhsa.gov/shin/content/SMA09-4427/SMA09-4427.pdf

  • Individuals experiencing mental health crises may encounter an array of professionals and non-professionals trying to intervene and help. The helpfulness and appropriateness of these efforts may vary, depending on a variety of factors. These guidelines, developed by a diverse expert panel that included individuals with mental illness as well as mental health professionals and advocates, attempt to define appropriate responses to mental health crises.

Zeller SL. Treatment of psychiatric patients in emergency settings. Primary Psychiatry 2010; 17(6): 35–41.
Available at: http://primarypsychiatry.com/treatment-of-psychiatric-patients-in-emergency-settings/

  • This article discusses different emergency care settings and models used with psychiatric emergencies as well as the types of interventions used with patients suffering from acute symptoms of suicidal ideation, agitation, psychosis, mania, intoxication, anxiety, and other presentations.

Agency for Health Care Research and Quality (11/20/2013). Service Delivery Innovation Profile: Emergency departments identify and support veterans at risk of suicide, enhancing their access to outpatient mental health services. Available at: http://www.innovations.ahrq.gov/content.aspx?id=3958

  • Emergency department clinicians and staff identify veterans at moderate risk of suicide, work with them to develop a safety plan, and follow up after discharge to ensure adherence to the plan and connections to community-based support, leading to better access to outpatient mental health services.
  • See related article: Knox KL, Stanley B, Currier GW, et al. An emergency department-based brief intervention for veterans at risk for suicide (SAFE VET). American Journal of Public Health 2012; 102(S1): S33-7.

Allen MH, Abar BW, McCormick M, Barnes DH, Haukoos J, Garmel GM, Boudreaux ED. Screening for suicidal ideation and attempts among emergency department medical patients: Instrument and results from the Psychiatric Emergency Research Collaboration. Suicide & Life-Threatening Behavior 2013, June; 43(3): 313–323.
Available at: http://www.ncbi.nlm.nih.gov/pubmed/23413776

  • Joint Commission National Patient Safety Goal 15 calls for organizations “to identify patients at risk for suicide.” This is the first multicenter study of suicide screening in emergency departments.

Cerel J, Currier GW, & Conwell Y. Consumer and family experiences in the emergency department following a suicide attempt. Journal of Psychiatric Practice 2006 Nov; 12(6): 341–7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17122695

  • In a survey of consumers and family members, individuals reported a range of negative experiences related to a ED visits following a suicide attempt.

Claassen CA, Larkin GL. Occult suicidality in an emergency department population. The British Journal of Psychiatry 2005; 186(4), 352-353. Available at: http://bjp.rcpsych.org/content/186/4/352.full

  • This feasibility study disclosed a surprising rate of occult suicidality in those attending an emergency department for non-psychiatric reasons. More than 11% of the sample acknowledged passive suicidal ideation and more than 8% admitted that they thought about killing themselves. Compared with the general population, those attending emergency departments may be at significant risk of suicide.

Horowitz LM, Bridge JA, Teach SJ, Ballard E, Klima J, Rosenstein DL, Wharff EA, Ginnis K, Cannon E, Joshi P, Pao M. Ask Suicide-Screening Questions (ASQ): A Brief Instrument for the Pediatric Emergency Department. Archives of Pediatrics and Adolescent Medicine December 2012; 166(12):1170–1176.

Ilgen M, Walton M, Cunningham R, Barry K, Chermack S, De Chavez P, & Blow F. Recent suicidal ideation among patients in an inner city emergency department. Suicide & Life-Threatening Behavior 2009; 39(5): 508-517.

Jacobs D. A Resource Guide for Implementing the Joint Commission 2007 Patient Safety Goals on Suicide: Featuring the Suicide Assessment Five-Step Evaluation and Triage (SAFE-T). (2007)
Available at: http://www.sprc.org/sites/sprc.org/files/library/jcsafetygoals.pdf

  • This document serves as a resource guide, using the SAFE-T protocol to facilitate implementation of the Joint Commission patient safety goal on suicide.

Joint Commission. A follow-up report on preventing suicide: Focus on medical/surgical units and the emergency department. Sentinel Event Alert; Issue 46, November 17, 2010. Available at: http://www.jointcommission.org/assets/1/18/SEA_46.pdf

  • This alert describes risk factors for suicide, risk reduction strategies, Joint Commission requirements, and suggested actions.

Knesper, DJ, American Association of Suicidology, & Suicide Prevention Resource Center. Continuity of care for suicide prevention and research: Suicide attempts and suicide deaths subsequent to discharge from the emergency department or psychiatry inpatient unit. Newton, MA: Education Development Center, Inc.; 2010.
Available at: http://www.sprc.org/library/continuityofcare.pdf

  • This is a comprehensive report offering recommendations for the ongoing care of patients at risk for suicide who have been treated in emergency departments and hospitals.

Larkin, G. L., & Beautrais, A. L. (2010). Emergency departments are underutilized sites for suicide prevention. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 31(1), 1–6. Retrieved from http://www.iasp.info/pdf/journal/2010_larkin_beautrais_emergency.pdf

Larkin, G. L., Smith, R. P., & Beautrais, A. L. (2008). Trends in US emergency department visits for suicide attempts, 1993–2001. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 29(2), 73–80.

National Institute of Mental Health. Emergency Department Suicide Screening Tool Accurately Predicts At Risk Youth. [date?]

National Institute of Mental Health. Ask Suicide-Screening Questions (1-page screening tool)

SoRelle R. (2011, March). EDs struggle to cope with suicidal patients. Emergency Medicine News, 23 (3), 1, 24–25. Retrieved from http://journals.lww.com/em-news/Fulltext/2011/03000/EDs_Struggle_to_Cope_with_Suicidal_Patients.1.asp

Substance Abuse and Mental Health Services Administration. After an Attempt: A Guide for Medical Providers in the Emergency Department Taking Care of Suicide Attempt Survivors. DHHS Pub. No. (SMA) 08-4359, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 2006. Reprinted by the Department of Veterans Affairs, Veterans Health Administration, 2008.
This tool is available at: http://store.samhsa.gov/shin/content/SMA08-4359/SMA08-4359.pdf

  • This brochure provides medical professionals with tips on how to enhance care in the emergency department for individuals who have attempted suicide. The brochure addresses assessment, communicating with family members and with other treatment providers, and HIPAA, and lists additional resources.

Suicide Prevention Resource Center. SPRC has a number of useful resources, including those listed below.

  • Suicide Prevention Toolkit for Rural Primary Care. (2013) -- This toolkit helps rural primary care providers apply suicide prevention practices; it addresses topics such as patient self-management of their own suicide risk and partnership development with mental health providers. Available at: http://www.sprc.org/for-providers/primary-care-tool-kit
  • Continuity of care for suicide prevention: The role of emergency departments. Waltham, MA: Education Development Center, Inc. (2013) -- This 6-page paper discusses recommendations and key steps for managing patients at risk for suicide in emergency departments, while ensuring that there is effective screening, follow-up and discharge planning. It is based on the Continuity of Care for Suicide Prevention and Research report, published in 2011 (see the item by Knesper DJ.). Available at: http://www.sprc.org/sites/sprc.org/files/library/ContinuityCare_Suicide_Prevention_ED.pdf
  • Is Your Patient Suicidal? (ED poster) -- A four-color poster that provides ED staff with information on recognizing and responding to acute suicide risk. Available at: http://www.sprc.org/library/ER_SuicideRiskPosterVert2.pdf
  • Suicide Risk: A Guide for Evaluation and Triage (poster) -- For ED staff, a short companion piece to the ‘Is Your Patient Suicidal?’ poster. At: http://www.sprc.org/library/ER_SuicideRiskGuide8.pdf
  • Using the ‘Is Your Patient Suicidal?’ (Poster+Triage Guide) -- A brief set of instructions for emergency department staff who display the poster and reference the resource guide. At: http://www.sprc.org/library/UsingIsYourPtSuicidal.pdf
  • Advancing Suicide Prevention Practice in the Emergency Department Setting -- This webinar presents promising and evidence-based strategies for preventing suicide among patients visiting the ED. Available at: http://www.sprc.org/training-institute/r2p-webinars/advancing-suicide-prevention-practice-emergency-department-setting
  • Safety Plan Treatment Manual to Reduce Suicide Risk, Veteran Version -- Safety planning is a brief clinical intervention that can serve as a valuable adjunct to risk assessment and may be used with veterans determined to be at high risk for suicide. At: http://www.mentalhealth.va.gov/docs/VA_Safety_planning_manual.pdf  Safety Planning Guide: A Quick Guide for Clinicians -- This pocket-sized safety planning guide reminds clinicians of the most important points to cover in collaboratively developing a safety plan with a patient. Available at: http://www.sprc.org/library/SafetyPlanningGuide.pdf
  • Suicidal Patients in the Emergency Department: Improving Care through Partnerships with Crisis Centers. (November 2011) -- This webinar describes potential new roles for crisis centers in working with EDs to improve continuity of care for suicidal patients after ED discharge. Three speakers with diverse expertise will highlight research, best practices, and current work to improve care for suicidal patients after an ED visit. Available at: http://www.sprc.org/training-institute/r2p-webinars/suicidal-patients-emergency-department-improving-care-through-partner
  • Advancing Suicide Prevention Practice in the Emergency Department Setting (March 31, 2011) -- This webinar presents promising and evidence-based strategies for preventing suicide among patients visiting the ED. Four speakers representing private health system, academic hospital, and VA health care settings will provide information about their programs and lessons learned. Available at: http://www.sprc.org/training-institute/r2p-webinars/advancing-suicide-prevention-practice-emergency-department-setting
  • Linking Together a Chain of Care: How Clinicians Can Prevent Suicide (March 30, 2010) -- An overview of the rapidly developing evidence-base for best clinical practices in suicide prevention. At: http://www.sprc.org/training-institute/r2p-webinars/linking-together-chain-care-how-clinicians-can-prevent-suicide

Taylor TL, Hawton K. Attitudes towards clinical services among people who self-harm: systematic review. The British Journal of Psychiatry 2009; 194: 104-110. Available at: http://bjp.rcpsych.org/content/194/2/104.full

  • From the Discussion: “This systematic review of the international literature about the attitudes towards clinical services of individuals who self-harm following an episode of self-harm has shown that in spite of differences in country and healthcare systems, many participants' reactions to and perceptions of their management were negative. Participants associated negative experiences of management with perceived lack of patient involvement in management decisions, inappropriate staff behaviour and lack of staff knowledge, problems with the format of psychological assessments and issues with access to after-care. Positive experiences of care were associated with greater participation in care and care decisions and the perception of staff as sympathetic. Service user suggestions for the improvement of services for individuals presenting to hospital after a self-harm episode included the provision of more information to individuals regarding their management and increased engagement in treatment decisions, better provision of information about self-harm for patients, families and the general public, better training for clinical and non-clinical staff about self-harm, and improved access to local services and after-care.”

Ting, SA, Sullivan AF, Boudreaux ED, Miller I, Camargo CA. Trends in US Emergency Department Visits for Attempted Suicide and Self-inflicted Injury, 1993–2008. Gen Hosp Psychiatry. 2012 September ; 34(5): 557–565.
Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3428496/

  • ED visit volume for attempted suicide and self-inflicted injury has increased over the past two decades in all major demographic groups.

Last Updated January 2014

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