Emergency rooms (ERs) across America are the daily front lines in trying to ward off death or serious disability for hundreds of thousands of Americans every year. They are constantly stressful arenas that pit skilled and dedicated doctors, nurses and health care workers against a myriad of problems from diseases and accidents, to strokes and death. It is not a place you would ever choose to be.
For better or worse in our health care system today, it is also the place of last resort that hundreds of thousands of people who are often in severe emotional pain turn to — people who try to commit suicide. In fact, many therapists will tell their actively suicidal patients, “If you feel like you’re going to harm yourself, call 911.” 911 wil get you a quick ambulance ride to the closest emergency room (if your county or state doesn’t provide access to a 24-hour psychiatric hospital, as most do not).
Generally speaking, most staff in ERs think and act like this doctor reveals — they don’t really care about most people who try to commit suicide and come to the ER because they view most of them as “not serious,” and therefore there’s little they, as medical professionals, can do for them. You see, ER staff are not really equipped or well-trained in mental health issues. Their focus is on life and death physical conditions, not mental ones. And so they dismiss most failed suicidal people as not really deserving their time, energy, or attention:
Many a time an irritated [ER] nurse has approached me and grimly suggested that we publish an educational flier titled “Suicide: getting it right the first time.”
If this makes it sound like we don’t take suicide attempts awfully seriously, then you’re right. Mostly it’s due to the preponderance of minor suicidal gestures over real attempts. Don’t think we’re not professional about it — we know how to rule out the serious threats and make sure that a safe disposition is accomplished. But we are not overly impressed with the low-level stuff we usually see.
From an ER doctor’s own mouth, they don’t take suicide attempts seriously. They are not “impressed” with the less serious attempts, as though a person’s attempt at suicide was some sort of contest done to try and win the ER staff’s respect.
This blog entry made me sad and enraged. Sad to see this kind of attitude from a real live medical doctor, because it seems to just reinforce the stigma of mental disorders in general — they aren’t real or serious and aren’t deserving of the medical staff’s time or attention. After all this effort of educating people about the “realness” of mental disorders, and we still have medical docs who think they are something less than the broken arm they just saw.
Really? This kind of attitude in 2008?? What will it take for the medical profession to wake up and smell the reality of serious mental disorders such as depression — a devastating condition that leads to 34,000+ people a year to successfully commit suicide. It’s the 11th leading cause of death in the U.S., and the 3rd amongst young adults and teens.
So I guess it’s not “serious” enough for the ER to pay anything but fake empathy and lip service to.
Maybe it’s an implication of the lack of appropriate psychiatric emergency services available in most local cities and towns. Maybe I’m expecting too much of a medical profession designed from the ground up to treat physical illness and diseases of the body, but not mental disorders and concerns of the mind.
But whatever the case, I find it increasingly difficult in recommending, in good conscience, that people seek out an ER in their time of need. A person seems to be just as likely to become demoralized and further depressed from the experience, than to actually receive compassionate care and treatment for their underlying mental disorder.
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ADHD Report» Blog Archive » Why ERs and Suicidal People Don’t Mix (3/20/2008)
From Psych Central's World of Psychology:
Mental Health is Medicine’s Second Fiddle - World of Psychology (3/26/2008)
10 Comments to
“Why ERs and Suicidal People Don’t Mix”
The problem is much worse than this. It isn’t just simply those who are in the ER for having attempted suicide. It’s any person considering suicide, any person there for another “psychiatric” reason, or any emotionally vulnerable person. Take the woman who was able to sue Beth Israel Hospital in Boston for absolutely traumatizing her; effectively raping her again. Doctors in ER’s have no business treating or even evaluating those in severe emotional crises. Often though, the nursing staff, who as a rule (in these instances), are less proffessional and empathic, are the most destructive to an emotionally distressed persons already fragile state. Additonally, where order and control are at a premium in an ER, ER’s will often resort to using unnecessary and further damaging chemical and physical restraints. Beyond all of this, we are in effect treating emotional distress as a medical disorder. Nothing could be more symbolic than a “psychiatric patient” going through an ER as if there were anything those facilities could be possibly do to help to begin with. And, or course, there is nothing they can do, and patients aren’t helped, they’re hurt more times than not. We’re arguing a small point of a much larger problem. This doesn’t make me as much outraged as it does annoyed. We’re not asking the right questions… Who ever decided it was in the best interest of those in severe emotional crises to go to a medical emergency room? That, in my opinion is simply a symptom of the fundamentally wrong way we view “psychiatric disorders”. Much more is needed than any patent pill to prevent people form getting to this point in the first place.
I’m writing from experience. The emergency rooms on the North Shore of MA are no better than any other.
In the book “Complications”, the author (a surgeon) expressed great frustration in dealing with people he could not fix. Doctors are great at dealing with people with physical problems and moving on to the next patient.
I think doctors recognize mental problems take a great deal of time to fix and dismiss them as “not serious” in order to assuage their frustration and guilt.
Self-injurers can tell you a million stories about how true this is. The first and last time I ever went to the ER because I thought I needed stitches, when the nurse found out it was self-inflicted, she tossed me in a back room with a police guard! So much for empathy.
On the occasions since then that my mental health has been at crisis level, I have taken myself to a dedicated psych hospital instead. It’s a pity that isn’t an option for many people.
I don’t know if this works any better, but on my psychologist’s answering machine, she suggests going to the ER and asking for the psychiatrist on call. I assume she says that out of some kind of knowledge of how ERs treat patients in crisis.
I had a friend who–before I knew him–was saying suicidal things on a phone conversation with a friend, who conferenced in a suicide hotline. The hotline people convinced him to come into the ER, and he was admitted to the psych ward for a few days. I got the impression that the ER was expecting him, but I can’t confirm that.
Anyone have personal experience with the hotlines? Do they make the path from the ER to actual psychiatric and psychological help less difficult?
I was always hesitant of the ER because of this type of thing. My doctors always told me to go there, and I was really scared.
Thankfully, when I did have to go, they were professional, sympathetic, and not hard to deal with in the least. (Which actually made me cry harder…but hey, hysterics is hysterics)
I’m very thankful a doctor like the one quoted wasn’t on that night…or they would have found a body. I needed gentleness, and was happy to receive it. This kind of thing…is just repulsive.
I was foolish enough to leave a comment on that doctor’s blog. He responded to all of us who dared question his omnipotence that he can actually tell when someone’s serious or not. Stupid guy–well, obtuse anyway.
I also recommend something we wrote last year on this very same topic:
WOW!
why can’t the hospitals get something like 2 rooms with at least one trained psychiatrist and a psych nurse that of course can work else where in the hospital but are always on call to handle these types of situations. I often encourage people to go to an emergency room on an online help site that I volunteer for. Never did I realize how unfair the treatment was. I’d like to think the hospital near my house would be understanding. They have a whole floor devoted to mental illness but I am even second guessing that. Just like they have the ER and childrens ER maybe there should be a mental health ER…. doesn’t have to be as big but something so that those patients get the right treatment
I’m fortunate to live close to a good hospital with an enlightened approach to mental health - they have an on-call mental health care crisis team that patients are steered towards. While I’ve never used them myself, a friend of mine did and was as positive as could be expected about the whole experience.
Bottom line—doctors are ignorant when it comes to mental illness–I think they need to go back to school and do more than what is required in psych residency. Would they say what they are saying about mentally ill people to their children? Their mother? Oh, they’ll care when their mother or child hangs themselves in their homes. On second thought–maybe they wouldn’t. I say get off your holier than thou kick–the only difference between them and mentally ill persons is a piece of paper which they earned most likely while high on crack. I smell lawsuits…………
What a joke doctors and nurses are.
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Last reviewed: By John M. Grohol, Psy.D. on 20 Mar 2008
