The American College of Emergency Physicians has published several policy papers in recent years addressing the issue of psychiatric patients presenting to emergency departments in lieu of a psychiatric care facility. Dr. Mendelson said that solving the suicide problem is partly a matter of resources, and that until these problems can be solved, "the fact that there are bad things happening" is not a surprise. "We need more money, especially more federal money, to deal with this," he said.
Dr. Schneider said that her hospital is fortunate to have a psychiatric department adjacent to its emergency department, social workers who screen every patient over age 70 – older male patients are at highest risk for suicide – and a psychiatric resident available much of the time. Most hospitals "would not have a psychiatrist or psychiatric nurse on duty and would not have immediate access to a psychiatric bed," she said. "But even we will hold these patients in the ED weekends or nights," she said.
Some of the ways Dr. Schneider and her team keep patients safe in the meantime, she said, involve "colored clothes and footies" that indicate to staff and guards an at-risk patient. Staff take evaluations from the friends of young patients who might not be candid about suicidal feelings. And any input from a paramedic with concerns about the state of a patient’s home is taken seriously.
The important thing, she said, is that all members of the emergency department team are empowered to act. "In emergency medicine, we believe everyone on the team can push the button. Anyone can come to the physician or nurse and say, ‘I’m worried about the patient in room 120.’ This is a team sport."