New report outlines hospital ED responses needed for youth suicide and self-harm

Suicide Prevention Australia has released a report, In their words: How to support young people in distress, on consultations and research examining suicide prevention approaches for young people.

Suicide is the leading cause of death for young people aged 15-24, therefore effective supports are needed when a young person seeks help for suicidal distress.

There are three key areas identified in the report:

1. A strategy to improve the experience for young people who present to a hospital emergency department (ED) experiencing suicidal distress
2. Alternatives for EDs when a young person presents in suicidal distress
3. Recommendations for policy reform.

The report is based on consultations with 85 young people, as well as input from 13 organisations that focus on youth suicide prevention and mental health.

Discussions with young people highlighted both positive and negative experiences with hospital EDs when they had presented for suicidal distress or self-harm. However, a consistent view was that EDs are inherently focused on physical health crises and would always struggle to create an environment that felt safe and focused on mental health and wellbeing.

Young people have provided feedback that alternatives to ED should have the following features:

• Both place-based and response team models are needed (i.e. a place young people can go to, as well as a form of crisis team that can go to young people where they are)
• Place-based services should be designed and located to protect privacy, and have an environment that feels safe and focused on mental health and wellbeing
• Staff must be able to provide both medical assistance and compassionate support
• There should be clear processes and choices.

Even with a system of alternatives, there will likely always be some level of presentations to ED of young people who have attempted suicide or self-harmed. Some of the recommendations to improve ED from the young people involved in the consultations were:

• Clearer processes
• Improved accessibility
• Further staff training on suicide and self-harm
• Specific suicide response staff including youth peer workers
• Reduced waiting times and provide support while waiting
• Create alternative waiting areas
• Increased privacy
• Improved follow-up support.

The report sets out seven recommendations for governments, including allocating specific funding for youth-specific alternatives to EDs, ensuring all programs and trials of alternative designs are co-designed with young people and reductions in presentations to ED are measurable. Other recommendations included allocating funding for hospital EDs to investigate options for improving the environment and responses for young people who present following a suicide attempt or self-harm.

Nieves Murray, CEO at Suicide Prevention Australia, said in their published media release, “Young people have said they need alternatives to emergency departments. Whether it’s a 24/7 safe space with youth peer workers and medical and mental health support staff or a crisis support team that comes to the young person’s home, it is clear we need models that are youth-specific and unique to their risk factors.

“We are calling on all state and territory governments to allocate funding to design and trial a number of youth-specific alternatives to emergency departments that will be co-designed with young people.”