New Study Shows Why the ER Can't Be the Only Option for People Who Are Suicidal

A newly published study found that people who went to the emergency room for self-harm or suicidal ideation had an increased risk of later dying by suicide. The results of the new study, which echoes previous research, suggests we need to do something other than tell people who feel suicidal to “go to the emergency room.”

What the Study Found

Published in JAMA Network Open on Dec. 13, researchers looked at hospitalizations records for nearly 650,000 people in California who went to the emergency department at least once between 2009 and 2011 for suicidal thoughts, self-harm, both or neither. They then looked at the cause of death for all those whose data was included in the study within a year of their ER visit.

After analyzing the data, the researchers concluded those who went to the ER for “deliberate self-harm” were nearly 57 times more likely to die by suicide in the year following an ER visit and those who presented for suicidal thoughts were about 34 times more likely to die by suicide. Researchers also discovered among the population they studied, males, people over age 65 and white people had a higher rate of suicide compared to other demographics.

It’s important to note that what the researchers classified as self-harm was most often what’s referred to as suicidal self-injury as opposed to non-suicidal self-injury. Suicidal self-harm is usually behaviors that could be lethal and, depending on your perspective, could be described as a suicide attempt. Non-suicidal self-injury typically refers to self-harm where the intention is to manage difficult or overwhelming emotions as opposed to a suicide attempt.

What Mental Health Advocates Say

This isn’t news for many people who struggle with their mental health. You’ve likely often heard if you’re suicidal you should call 911 go to the emergency room (ER). However, ERs aren’t necessarily equipped to handle mental health crises, and the resulting treatment can actually make someone feel worse. According to the National Alliance on Mental Illness (NAMI), 40% of those who went to the emergency room for a mental health emergency rated their experience “bad” or “very bad.”

“The nurses and doctor I came into contact with were not sympathetic to my mental health crisis and did nothing to ease my anxiety or fears instead threatening me to do as I was told or I would be restrained,” one ER psychiatric patient told NAMI.

Meanwhile, in the U.S., only 10 states mandate suicide prevention training for general health care professionals. Once someone who is struggling with suicidal thoughts gets to the ER, they’re met with people who likely don’t know how to respond. The result can be restrictive care that ends up becoming its own risk factor for future suicide attempts, as the recent study might suggest. Plus, advocates say that for many people, the fear of being “locked up” may cause those in crisis to mask their struggles instead of address what’s going on to get the help they need.

“Coercively sending someone to the ER has the potential to traumatize someone because oftentimes doctors/staff don’t take the needs and concerns of its patients seriously because they are labeled mentally ill,” mental health advocate Rudy Caseres told The Mighty. “Also people can feel like they have to act like a ‘model’ patient in order to avoid being placed in a psychiatric hospital, which leads to them not addressing the issues that led to their crisis in the first place.”

If you’re feeling suicidal, you can always call the National Suicide Prevention Lifeline at 1-800-273-8255 or reach the Crisis Text Line by texting “START” to 741741. And in many cases, sometimes calling 911 or going to your emergency room may be the best or only option if you’re in immediate danger.

However, here are four community-based approaches looking to reduce the risk of suicide associated with ER visits in a mental health emergency.

1. Crisis Respite Centers

Recommended by advocacy organizations such as Zero Suicide, respite centers provide voluntary, short-term, overnight support in a non-clinical environment staffed by people who have been there. The programs allow people to reset their mental health in a safe environment in a comfortable setting. Peer-run respite centers are currently available in 14 states across the U.S., according to Peer Respites Action & Evaluation. Though more research is needed, early studies suggest for many people, peer respite is more effective than a trip to the ER.

Search for a peer respite center near you using the National Empowerment Center’s database.

2. Peer-Run Warmlines

Sometimes when you’re having suicidal thoughts, you just need someone to really listen and validate your experience. Many people find this support — and reduce their suicidal thoughts — through peer-run warmlines. These warmlines are answered by people who also live with mental illness and the focus is on making sure you are heard by someone who really gets it.

Find out what warmlines are available in your area by checking out Warmline.org.

3. Structured Peer Support Groups

Peer support groups led by people with lived experience of mental illness can take many forms in your community. For example, Intentional Peer Support connects peer groups with resources for constructive dialogue and mutual support. Organizations like Peerly Human offer a weekly “Deadly Serious –Talking Openly About Suicide” peer support group that you can join online or via phone. Western Mass Recovery Learning Community supports Alternatives to Suicide peer support groups. What these groups have in common is a co-created space to manage suicidal ideation and other mental health struggles without setting foot in an ER.

For other peer support group resources, check out the National Empowerment Center.

4. WRAP for Life

WRAP, which stands for wellness recovery action plan, was developed in 1997 as “a self-designed prevention and wellness process.” Your WRAP plan might cover everything from developing coping skills to building support and developing crisis plans. Its initial purpose was more general, but WRAP for Life also includes guidance for those who wish to use the program to address suicidal thinking specifically.

To learn more about WRAP for Life, visit WRAP’s website.

What’s your experience been? Share with us in the comments below!