Suicide risk assessment in emergency departments: a mixed-methods study of clinician practices in Scotland

Abstract

Background: Despite suicide being a global public health issue, limited research exists exploring suicide risk assessment practices in emergency departments. This study investigated current suicide risk assessment practices and clinician experiences across a national sample of emergency department clinicians in Scotland. Methods: All emergency departments in Scotland (n = 23) were eligible to participate in this mixed-methods study. In total, 51 clinicians across 17 emergency departments completed a descriptive survey of current suicide risk assessment practices, and six clinicians participated in follow-up semi-structured interviews to investigate their experiences. Interviews were analysed using thematic analysis. Findings: The survey identified substantial variation in practice between emergency department clinicians in Scotland. Thirty-five (68.6%) participants were using a suicide risk assessment tool in their workplace, with most using locally developed proformas (n = 20, 62.5%) or the SAD PERSONS scale (n = 13, 40.6%). Remaining participants (n = 16, 31.4%) did not use a suicide risk assessment tool. The qualitative analysis of clinicians’ experiences identified four major themes including: current experiences, e.g., challenges with assessment; components of suicide risk assessment, e.g., risk and protective factors; clinical decision-making; and suicide risk assessment needs, e.g., training. Discussion: This novel study concluded that there is substantial variation in suicide risk assessment practices between emergency department clinicians in Scotland. Furthermore, clinicians find this challenging and discuss further training needs, clearer guidelines, and the improvement of risk assessment tools. These findings should be considered in the development of suicide risk assessment practices; in particular, to encourage consistency across practice.