Psychiatry

“In 2004: 1.5% of Emergency Department (ED) attendances are from those with mental health issues. These patients often remain in departments for prolonged periods awaiting psychiatric assessment.”

Mental health in the ED

The National Audit Office review of Emergency care services in 2004 found that 1.5% of Emergency Department (ED) attendances are from those with mental health issues.

These patients often remain in departments for prolonged periods awaiting psychiatric assessment [1]. In 1995: 150,000 patients were seen in EDs with deliberate self-harm-related attendance [2]. Those who have had a previous attempted suicide have an increased risk, 30-40 fold more, than the general population of completed suicide [3]. The Royal College of Psychiatry (RCP) has produced guidance relevant to ED staff which include the assessment of self-harm and safety for trainees [4].

Doctors need to familiarise themselves with safety guidance to ensure personal safety. An accurate initial assessment may include a psychiatric history and mental state examination, including risk assessment of the patient.

Disturbances in mental state may be due to organic or non-organic causes and the features which help distinguish between these groups will be discussed.

Suicide and self harm

Suicide annual incidence = 1 in 10,000

Suicide = 1% of all deaths

The lifetime incidence of suicide in psychiatric disorders is as follows:

  • Schizophrenia 10%

  • Affective psychosis 15%

  • Alcoholism 15%

Suicide rates are substantially higher in people suffering from a mental illness.

Self harm annual incidence = 2-3 per 1,000

Repeated self harm/suicide = 1% in 1st year / 10% life time risk

Remember: Suicide is the second most common cause of death in young males (RTA is first). In England and Wales the most common method of suicide is self-poisoning with car exhaust fumes in men, and drug overdose in women.

LEARNING OUTCOMES FROM COMPLETING THE TASKS

  • Employ a risk assessment strategy in a patient who presents with self harm and formulate a management plan.

  • List the risk factors for further self harm and suicide following an act of self harm.

  • Describe the main principles of the Mental Capacity Act and how to apply them in practice.

  • Differentiate between organic and non-organic causes for altered behaviour and thinking.

  • Evaluate the features in a patient, which may compromise safety in the Emergency Department.

Tasks

Complete the following before the face-to-face session:

Task 1 & 2: Self Harm Assessment

Duration: 20 & 30 mins

These 2 modules give a good overview related to the Emergency Department with regards to risk assessment and disposition of psychiatric patients. They use some very good cases that would present to any Emergency Department and also form part of the Foundation Curriculum. 

These modules are accessed via the e-learning for health platform, you must be registered to access it (this is free to anyone with an NHS/ UHL email account). To find out how to register view the video in the introduction to the Moodle. For this module you will need access to the Foundation Programme (FND12) course and you should undertake modules: 03-13 Managing Self Harm and 03-14 Self Harm Assessment (this is in section 08 Recognition and Management of the Acutely Ill Patient - Self Harm). If they do not open you may need to enable popups in your browser.

Task 1

Task 1

Task 2

Task 2

Task 3: Psychiatric Patients in the ED

Duration: 60 mins

This modules covers very well patients that come in confused to the Emergency Department and helps with differentiating between organic and non-organic causes for confusion and when to investigate patients. Click on the link or screenshot below.

Task 4: Toxicology in the ED

Duration: 10 & 20 mins

These two videos are from Canada but they cover the basics of toxicology and poisoning in the Emergency Department very well. YouTube will not work on UHL computers but will in any other system.

TASK 5: The Mental Capacity Act

Duration: 8 mins

This short podcast from the Alzheimer's Society covers the Mental Capacity Act (2005). It is obviously put in the context of patients with Dementia, but it covers the basic principles of the act as applied to anybody.

#EM3 Content

Lightning Learning

CASE DISCUSSION

We have written a series of interactive cases (wikis) with short answer questions to be answered by trainees prior to the face to face teaching sessions. Currently this is only available to East Midlands Trainees.

Answer one or two questions before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. We will also provide tutor comments. If you find good resources that answer a question why not include links in your comment.

Part of the face-to-face teaching will be spent discussing the case(s) below:

“A 23 year-old female, weighing 62kg was brought to the Emergency Department via ambulance after it was discovered that she had taken an overdose...”
“A 22 year old man, weighing 100kg, is brought to the Emergency Department via ambulance after taking an overdose of 48 x 50mg tablets of amitriptyline...”

ADDITIONAL RESOURCES

Here are some extra resources to review if you want more information:

COURSE FEEDBACK

Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form:

Updated: 5th January 2017