Presentations to the emergency department with self-harm or suicidal behaviours: A role for digital mental health services?

Abstract

Emergency Department (ED) is an important site for assessing people presenting with self-harm or suicidal behaviors. Digital mental health services (DMHS) offer evidence-based interventions for mental health issues, but are often under-utilised, and information about them is rarely provided in ED. This feasibility study explored whether offering information about a DMHS to individuals presenting to ED with self-harm/suicidal behaviors resulted in self-enrolment in DMHS interventions for anxiety, depression and/or chronic pain.

Methods: all individuals aged 18+ presenting with self-harm/suicidal behaviors to a metropolitan ED were screened for symptoms of anxiety, depression and/or chronic pain. Those with these symptoms were invited to participate in a study investigating enrolment with a DMHS. Study participants were provided with information about DMHS and followed up at one month.

Results: 260 individuals presented with self-harm/suicidal behaviors over the 6-month study period. Many reported low mood (73.5%, n = 191) anxiety (67.2%, n = 174) and/or chronic pain (18.5%, n = 48). Half of those eligible for DMHS agreed at point of ED discharge to be contacted about participation in the DMHS study (51.4%, n = 108). One-third of these participated in the study (35.2%, n = 38). Rates of past-month high-risk SB (65.8%, n = 25), depression (92.1%, n = 35), anxiety (78.9%, n = 30) and chronic pain (57.9%, n = 22) were very high. Of these, 39.5% (n = 15) self-enrolled with the DMHS; almost all (80.0%, n = 13) engaged with an online intervention.

Conclusions: A subset of people presenting to emergency department with suicidal behaviors will engage with DMHS. Better understanding is needed of factors contributing to uptake of DMHS in this group.

Keywords: Chronic pain; Digital mental health service; Self-harm; Suicidal behaviors; Suicide.