Mental Health Consultation via Telehealth to Optimize Care for Emergency Department Patients with Suicide Risk

Presenter:

Michael C. Freed, Ph.D., EMT-B
Division of Services and Intervention Research

Goal:

Emergency departments (EDs) are critical settings for suicide preventive efforts. Over 500,000 adults in the U.S. present annually to an ED with self-injury, and many more with suicidal ideation. A recent study found that 48% of decedents had at least one ED visit in the year before death, and 20% in the month before death. There is increasing evidence for a number of ED-based suicide prevention practices, yet uptake of these practices by ED providers remains insufficient. One key barrier consistently identified by the emergency medicine community is limited access to mental health specialty consultation. Without such consultation, there is limited provider assessment and evaluation of patients’ suicide risk, few brief interventions, and unknown adequacy of appropriate disposition of at-risk individuals (hospital versus outpatient referral). The goal of this proposed initiative is to identify feasible approaches to telehealth-supplied suicide prevention practices, and how this consultation affects patient suicide-related outcomes that include intentional and non-intentional injuries and mortality, and suicide related-health utilization patterns. 

Rationale:

Suicide deaths could be prevented if EDs were better equipped to deliver evidence-based suicide preventive care. These care practices include universal risk detection efforts that can double the number of individuals in need of suicide prevention treatment; brief interventions such as Safety Planning Intervention; and follow-up telephone contact that have resulted in fewer repeat suicide attempts (30 to 50% reduction). Some EDs have begun to address the shortage of ED-based mental health provider expertise by using telehealth mental health specialists. Responses to a recent NIMH Request for Information on this topic indicated overall feasibility and ED provider satisfaction with telehealth mental health services. ED providers also saw the potential of telehealth benefits for suicide risk consultation, specifically with regard to reductions in patient boarding (keeping patients in the ED until an inpatient bed is available). A number of questions remain with regard to how telehealth services suicide prevention care affect ED work flows. Most importantly, it is not known whether telehealth-provided ED suicide prevention services are related to patients’ immediate, as well as longer term suicide morbidity and mortality outcomes. Therefore, this concept aims to learn of feasible ED telehealth guided/provided suicide prevention practices, and their potential benefits for patients’ immediate and longer-term outcomes. Examples of study questions could include, but are not limited to:

• Does access to telehealth mental health consultation affect the proportion of patients who are considered at risk for suicide?
• Does use of telehealth mental health consultation affect the proportion of ED patients who are triaged to inpatient care for suicide risk?
• Does use of telehealth mental health consultation increase the duration of ED visits for at-risk individuals, but ‘pay off’ with less boarding time?
• Does use of telehealth mental health consultation affect the rate of near-term, and longer term patient suicide-related events (injury and mortality, health care utilization), after an “index” ED visit when a patient was identified with suicide risk?