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Improving Care for Child and Adult Behavioral Health Clients with Suicidal Ideation and Behavior in Emergency Department Settings Conference

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Meeting Summary
Baltimore, Maryland

Sponsored by:
Substance Abuse and Mental Health Services Administration (SAMHSA)

On July 26–28, 2011, staff from the National Institute of Mental Health (NIMH), Division of Services and Intervention Research, partnered with the Substance Abuse and Mental Health Services Administration (SAMHSA), representatives from the Institute for Behavioral Healthcare Improvement, and the Department of Veterans Affairs (VA), in the planning and coordination of a meeting to discuss suicide prevention in Emergency Department (ED) settings. The conference was held in conjunction with the National Suicide Prevention Center Lifeline Crisis Centers Conference. The goal of the meeting was to review the empirical basis of and consider best practices for the assessment and care of children and adults with suicidal thoughts and behaviors who present to hospital EDs/urgent care settings. Related goals were to (1) identify the specific practices that not only lead to improve clinical outcomes, but also improve the satisfaction of clients and staff; and (2) identify ways to encourage the development of improvements in ED operations through the use of these practices. In order to achieve these goals, meeting participants represented an array of backgrounds/disciplines, including researchers, program administrators, policy makers, direct service providers, and consumers.

Richard McKeon, PhD, Chief of the Suicide Prevention Branch at SAMHSA opened the meeting, along with David Litts, OD, Director of Science and Policy, Suicide Prevention Resource Center, and Jane Pearson, PhD, Chair, NIMH Suicide Research Consortium. Dr. McKeon provided updates on the National Strategy for Suicide Prevention, highlighting the need for increased efforts focused on Objective 7.1, “Promoting Post-ED Discharge Follow-Up, Safety and Recovery.” Drs. Litts and Pearson provided updates on the recently formed National Action Alliance for Suicide Prevention . They presented both the structure and the mission of the Alliance, as well as the processes currently underway to inform research efforts pertaining to decreasing the overall incidence of suicide in the United States. The morning of Day 1 then shifted to presentations reflecting the perspectives of the stakeholder groups in attendance: reactions of behavioral health consumers to their experiences in ED settings; the experience of ED physicians in managing psychiatric crises and suicidal patients; quality improvement efforts from behavioral healthcare organizations; and a summary of objectives from a representative of The Joint Commission, with specific attention to National Patient Safety Goal 15.01.01.

The afternoon focused on research perspectives, with overviews of the state of the research literature with respect to interventions for suicidal adults in the ED, and a parallel presentation focused on pediatric populations. Researchers currently conducting ED suicide prevention and intervention research with both adult and adolescent populations presented their work, including the NIMH-supported Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study and Safe Vet, the ongoing VA-sponsored multi-site clinical demonstration project. Building on the comprehensive framework of the state of the field established during Day 1, Days 2 and 3 of the meeting focused on models to effectively change practice in ED care settings, and workgroup discussions to identify research gaps and next steps to inform a research agenda.

Comprehensive proceedings, including recommendations for next steps and research recommendations are forthcoming.

For more information please contact Amy Goldstein, PhD, goldsteinam@mail.nih.gov, or 301-496-4227.