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Abstract
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Suicide is one of the most serious issues in society and public health. In The Lancet Psychiatry, Keith Hawton and Jane Pirkis1
recently summarised the current situation, measures taken, and clinical development in suicide prevention globally. One type of suicide that deserves more attention, especially from emergency medicine physicians in China, is in-hospital suicide.
Psychiatric disorders are not well recognised in China and stigma is still prevalent. When a patient experiences suicidal ideation, whether an inpatient or an outpatient they are usually reluctant to turn to others for help, including their families or mental health-care professionals. Primary care in China is poorly developed and some hospitals have no psychiatry department; therefore, patients with suicidal thoughts often seek assistance at the emergency department. This situation makes emergency physicians key players in suicide prevention. However, although emergency physicians are trained to manage patients who are intoxicated or who have experienced trauma due to attempted drowning, which are common consequences of attempted suicide, they are not trained to recognise, manage, or prevent suicidal thoughts or intent.
Safety planning can reduce occurrence of suicide in the emergency department,but applying such planning to all of the patients in the emergency department is impractical. Emergency departments in China are usually overcrowded, with doctors routinely seeing over 100 patients within an 8 h shift. Patients at risk of death by suicide can be triaged with clinical judgment and by use of an established scoring system but such triage requires clinical experience.
Additional efforts are needed to prevent in-hospital suicide in China. First, patient and family education on suicide prevention should be promoted to improve awareness and establish family support. Second, health-care providers should receive training to promote timely recognition of warning signs of suicidal ideation behaviour. Third, access to means to attempt suicide while in-hospital should be restricted, including barring access to high-risk areas of the hospital such as rooftops and building protective barriers across hospital windows.4
Finally, medical resources should be provided, such as an in-house psychiatrist or crisis worker, and if these are not available, then resources should be deployed, such as advice via telemedicine or artificial intelligence.
In-hospital suicides in China are a unique issue shaped by the country's distinctive cultural, social, and health-care environment. However, China might also offer valuable insights for other countries with limited resources in emergency medicine. ...
Language: en |