Parasuicide assessment in the emergency department

Parasuicide is an important predictor of future suicide. We collected information on all parasuicides presenting to the emergency department of a general hospital over a 3-month period. We examined detection rates, referral patterns and compared emergency department risk assessments of parasuicide with those of the psychiatric liaison team. We detected 123 parasuicides. One hundred and five (85.4%) were detected in the emergency department. Ninety-five (77.2%) were referred to the liaison psychiatry service. Liaison psychiatric risk assessment agreed with emergency department risk assessment in all cases that emergency doctors judged to be at low risk of suicide. However in cases that emergency doctors judged to be high risk the liaison assessment agreed in only 38.5% of cases. Emergency doctors appear to be appropriately cautious in their assessment of risk. However, parasuicides regularly go undetected in hospital and are not always referred for psychiatric evaluation when detected. More training in the detection, assessment and management of parasuicide is required for emergency doctors.