Accessing Help in the ED: Phase 2 Study

The Experiences & Support Needs of Family/Supporting Adults Who Accompany Someone to the Emergency Department with Self-Harm, Suicide-Related Ideation or Suicide Attempt

Phase 2 Study Findings

72% of families & carers received no suicide prevention guidance after a loved one presented to an Emergency Department.

Background

The Emergency Department (ED) is often the first point of contact for people experiencing self-harm or suicidal thoughts. In Ireland in 2021, there were 11,415 ED presentations for self-harm, with many more presenting with suicidal ideation.

After discharge, families & carers are typically left to manage patient safety — yet few receive guidance on how to do this.

While the National Clinical Programme for Self-Harm & Suicide-Related Ideation (NCP-SHI) highlights the vital role of carers, no Irish study had systematically explored their experiences until now.

This Phase 2 study, conducted by Trinity College Dublin in partnership with 3TS, addressed that gap.

"Families play a critical role — both in the ED & after discharge — but are often left in the dark. Simple steps such as providing a safety plan & clear guidance could save lives."

_{— Professor Louise Doyle, lead researcher}

Headline Findings

• 72% of carers received no information on suicide prevention
• 71% received no guidance on supporting the person after discharge
• 72% said no safety plan was developed for the patient
• Over half felt staff lacked the skills & confidence to care for suicidal patients
• 68% reported that a mental health assessment was carried out — but over one-quarter said no assessment was offered, or the person left before being seen
• The ED environment was often unsuitable: noisy, crowded, with long waits & little privacy

"Tragically, some participants lost their loved one to suicide after the ED visit — and felt this might have been preventable with better services. We believe a dedicated, 24/7 Suicide Emergency Department is urgently needed."

_{— Noel Smyth, Chairman 3TS}

Study Methods

• Design: Exploratory qualitative online survey, co‑developed with two PPI contributors
• Participants: Adults (18+) who accompanied someone to an Irish ED for self-harm, suicide attempt or suicidal ideation within the past five years
• Recruitment: Online & social media platforms via mental health organisations
• Analysis: Content analysis of open-ended responses
• Ethics: Approved by Faculty of Health Sciences Research Ethics Committee, TCD

Sample Profile (n = 239)

• Gender: 88% female
• Age: 18–81 (mean = 43)
• Relationship to Patient: Parents of adults (22%), parents/guardians of minors (21%), siblings (16%)
• Location: Dublin EDs (34%), broader Leinster (24%)
• Presentation Reasons: Suicide attempt (56%), suicidal ideation (52%), self-harm (38%)

Detailed Findings

Patient Assessment in the ED

• 68% reported that a mental health assessment was carried out
• 52% of carers were included, mostly to provide collateral history
• Inclusion led to better understanding, communication & joint decision-making
• Exclusion resulted in gaps in information & reliance on possibly minimised patient accounts

Safety Planning

• 72% reported no safety plan was developed
• Of those with a plan, only 46% of carers were involved
• Carers strongly wanted jointly created safety plans linking to aftercare

ED Environment & Staff Interactions

• Challenges: Long waits, unsuitable physical spaces, focus on medical stabilisation over psychological needs, occasional negative attitudes
• Positive experiences: Some reported compassionate, skilled care — e.g. where Clinical Nurse Specialists (CNS) were involved

Information & Support on Discharge

• 72% received no suicide prevention materials
• 71% received no guidance on how to support the person after discharge
• Desired content: Clear advice on warning signs, support strategies, emergency contacts & follow-up pathways

Carer Recommendations for Improvement

• Improve staff education on self-harm & suicide empathy
• Always treat patients & carers with respect & attentiveness
• Ensure availability of specialist mental health staff in EDs
• Provide sensitivity training & promote non-judgemental communication

Recommendations for Practice

Standardised Assessment & Care Planning

• Fully implement NCP-SHI principles across all EDs
• Guarantee mental health assessments for all self-harm/suicidal presentations
• Involve carers in assessment & safety plan development

Compassionate Staff Interactions & Training

• Promote compassionate, non-stigmatising language in all ED interactions
• Provide ongoing staff education on brief-interaction empathy & suicide awareness

Information Provision & Aftercare Support

• Supply clear verbal & written guidance to carers covering:
  • Warning signs
  • Support strategies
  • Emergency contacts
  • Aftercare pathways
• Format materials in plain English & suitable for varied literacy levels

About the Authors

Prof Louise Doyle,  Dr Brian Keogh, Dr Jean Morrissey, Mr Ciarán Carr
Contact: louise.doyle@tcd.ie