attempted suicide

Researchers examine a program called Guidance to Care in emergency departments following cases of attempted suicide, in an attempt to decrease the suicide rate.

Emergency departments in the Netherlands witness 14,000 cases of attempted suicide in a year. These numbers have been growing and have become a source of concern since attempted suicide shows a high correlation with increased rates of completed suicide. The rate of re-attempting suicide is quite high as well, and therefore it is important to employ good follow-up care for an individual who has attempted suicide after discharge from the emergency department. The difficulty arises when the follow-up care provided by the healthcare system is declined by the person, thus making it hard to inquire about their wellbeing and reduce the incidence of that individual re-attempting suicide.

Despite the above dilemma, there has been no research to date quantifying differences between patients who accept post-discharge guidance and those who do not. This lack of knowledge may translate into ineffective follow-up treatment, and this has recently sparked clinical research in this area. Researchers in the Netherlands aimed at understanding patterns among individuals who declined follow-up care after discharge. The Netherlands Mental Health Survey and Incidence Study has found that one-third of the people who reported having attempted suicide did not seek help for battling psychological troubles. Clinicians blamed the fear of negative experiences or stigma of addressing mental health issues as a possible cause of this unwillingness to seek help.

A study recently published in BMC Psychiatry assessed the effectiveness of a program called Guidance to Care. Guidance to Care was developed using existing research and aims to overcome potential barriers to post-discharge care. The research conducted in this area was performed for 20 months in the Netherlands at the emergency department of an urban hospital called OLVG-West Amsterdam.  All patients who presented to the emergency department were evaluated through a questionnaire for a history of suicide attempts or any form of intentional self-harm. Those who were found to have positive results were referred to a psychiatrist. Patients were broadly classified into two categories – those who accepted follow-up treatment and those who did not.

In total, 257 patients were included in this study. Follow-up treatment was accepted by 77% and demonstrated that the acceptance of follow up therapy for attempted suicide is high among patients who presented to the emergency department. Suicide attempters who reported loneliness as a reason for the attempt showed a positive relation to acceptance. An ethnic relationship to receiving follow-up care was also found in the study. Patients with a non-Western ethnicity, especially of the Turkish and Moroccan ethnicities, more frequently declined contact by the follow-up care nurse. Also, patients who currently did not receive care were significantly more often of non-Western ethnicity and younger than 25 years old.

Unfortunately, although the Guidance to Care program proved effective in the context of this study, the researchers cannot yet make broad recommendations regarding its implementation. More research is required and this study brings together a number of directions for further research. First, researchers need to investigate the reasons as to why an individual would accept or decline care. Future studies also need to look into methods of making follow-up care more accessible and provide the means to break stigmas around mental health.

Written by Dr. Apollina Sharma, MBBS, GradDip EXMD


Dekker, W. P. H., et al. “Acceptance of guidance to care at the emergency department following attempted suicide.” BMC Psychiatry. 17.1 (2017): 332.

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