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More often than not ER docs don’t request psychiatric evaluations on patients who come in with evidence of cutting or other types of self harm.
This is true for as many as half of the people who come in with evidence of self harm. And equal number don’t get the follow up therapy recommended to them within the following month, according to researchers who tracked claims made to Medicaid over a one year period.
And yet, these are the people with the highest rates of suicide according to researchers led by Dr. Mark Olfson, a psychiatrist at Columbia University in New York. The suicide rate for people who have recently been hospitalized for self harm is 30 to 130 times higher than for the general public. “If you present to an emergency department with deliverate self-harm, that is something that should receive amental health assessment during the visit,” he explained to Reuters Health.
Less than 48 percent of patients showing signs of cutting, overdose or other evidence of self harm were evaluated for psychiatric problems. The degree of self harm, burning versus cutting for instance, had no impact on the decision to evaluate.
It could be that some of these patients were referred back to their primary care physician. This may be a method of evaluation for those that the ER doctors assess as low risk without a prolonged (and expensive) psych evaluation.
“By the time they are in the ER… they frequently say, ‘I had thought about (suicide), but now I feel better and I’m not going to do it,” said Dr. Larry Baraff from UCLA Emergency Medical Center.
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