Page 1

Hi, I'm Dr. Gibson. I work in a hospital E.D., where I've been on staff for 26 years. I have a lot of experience identifying and referring patients who are at-risk for suicide and substance abuse.

I'm here to talk to you about when and how to screen for suicide and substance abuse risk. I'll also teach you practical skills that you can put to use right away in your E.D.

But first I'd like to tell you a story to illustrate why this topic is so important. Last week I trained an E.D. team from the hospital across town. They told me they'd lost a patient, but not in the way you'd normally think.

A teenage girl came into the E.D. with abdominal pains. They diagnosed her with cellulitis at the site of a navel piercing she'd given herself. They removed the navel ring, cleaned and dressed the area, and released her from the E.D. on P.O. antibiotics with a referral to follow up with her primary care physician.

A few days later, she was rushed back to the E.D., but this time, she was D.O.A. She'd hung herself. When the team realized it was the same patient they'd treated just a few days earlier, they were shocked and really discouraged. When she came to the E.D. initially, they had an opportunity to talk to her about thoughts of hurting herself; but, because her chief complaint wasn't related to psychological distress and she had no overt signs that she was suicidal, they never screened her.

It's challenging for E.D. staff – especially when you don't have behavioral health experts or social workers stationed in your E.D. So, in addition to your other duties, staff have to recognize suicide or substance abuse risk and decide on psych-related treatment plans themselves. This can be especially difficult when the patient's chief complaint seems unrelated.

Some E.D. staff have limited experience and education in mental health assessment; you've all had basic training on this at some point in your careers, but you're specialists in emergency medicine, NOT mental or behavioral health.