“A Sustained, Productive, Constructive Relationship with Someone Who Can Help”—A Qualitative Exploration of the Experiences of Help Seekers and Support Persons Using the Emergency Department during a Suicide Crisis

By Demee Rheinberger, Diane Macdonald, Lauren McGillivray, Myfanwy Maple, Michelle Torok, Alexandra Nicolopoulos and Fiona Shand

Published 29 Sept 2021

Context

For Australians experiencing a suicide crisis, the emergency department (ED) is the recommended point of contact for support, intervention and to ensure personal safety. But, negative ED experiences can compound the problem and deter individuals from returning, thus impacting future suicide risk.

Research and findings

In-depth semi-structured interviews with 17 help seekers and 16 support persons (family or friends who accompany a help seeker to ED) were conducted to uncover how ED is experienced when they present during a suicidal crisis. All participants wanted “a sustained, productive, constructive relationship with someone who can help” during the ED visit; this core concept guided the thematic analysis. Two key themes were identified, exploring the interpersonal and systemic aspects of the ED visit, for which there were both ‘pathways’ and ‘roadblocks’ to a positive experience. There were more roadblocks than pathways reported by participants.

Interpersonal factors included:

• Whether interactions with ED staff were positive or negative
• Presence of a support person facilitated better quality care for the help-seeker.

Systemic factors included:

• Chaotic environment, long waiting times and inability to access staff were roadblocks
• Whether mental health assessments were rushed, transactional and appeared to be a ‘box ticking’ exercise (roadblock) or detailed and individualised (pathway).

Implications

This research supports the need to increase funding and improve the ED environment to better support people in suicidal crisis. Some ways the ED environment may be improved are: providing a separate waiting area for mental health presentations, increased presence of mental health staff in EDs, and providing mental health suicide prevention training to ED staff. Further investment and evaluation of alternative support services that offer a calmer environment for those in suicidal crisis, e.g. safe spaces, will also help to fill this need.