Mental health practitioners' views on assessing suicide risk in the emergency department: navigating a challenging...

The Emergency Department (ED) is a key setting for suicide risk assessments. In the UK, mental health professionals (MHPs) in psychiatry liaison teams assess suicide risk.

This study aimed to explore how MHPs in EDs experience and approach the assessment of suicide risk for people presenting for suicidal ideation and/or self-harm.

We interviewed 22 MHPs from one hospital (England) on their views of conducting psychosocial assessments. Interviews were recorded, transcribed and analysed using inductive thematic analysis.

MHPs described various challenges, summarised in four main areas: the complexity of assessing suicide risk and lack of confidence in some patients/ accounts, the dynamic nature of risk, the impact/barrier of a structured assessment form, and institutional pressures and lack of resources. We identified views and attitudes that delegitimise patients. While such practices at an individual level need to be addressed, we posit this reflects organisational pressures that stifle practitioners' ability to prioritise therapeutic alliance.

It is unsurprising that MHP experience moral injury that can be manifested as amplify biases and compassion fatigue. This calls for changes to support staff striving to make assessments therapeutic and we recommend both top-down and bottom-up initiatives to improve the experiences of MHPs and their patients.