Emergency department readiness to implement best practices in suicide prevention : a mixed methods study of provider perspectives

Emergency departments (EDs) are often the point of contact for individuals at risk for suicide. According to the Canadian Mental Health Association–BC Division’s (CMHA-BC) Suicide Risk Reduction Framework, universal suicide screening is a best practice for suicide prevention; however, implementation barriers and readiness for universal suicide screening have not been assessed. The Interior Health evaluation - conducted collaboratively by the CORE Lab, CMHA-BC, and Interior Health - assessed implementation barriers to universal suicide screening. The current study aims to answer the following from phase 2 of the evaluation: to what extent are ED healthcare providers in Interior Health reporting readiness to implement universal suicide screening? A mixed methods design analyzed cross-sectional survey data gathered from ED healthcare providers (N = 125). Quantitative analyses included ordinal regressions to determine the importance of five predictors (i.e., ED location, mental health training, suicide-specific training, Columbia Suicide Severity Rating Scale (C-SSRS) familiarity, and helpfulness of an integrated mental health specialist) on two outcomes (i.e., comfort and perceived competence to care for patients at risk for suicide). Qualitative data was analysed using reflexive thematic analysis. Mental health training (b = 0.89, SE = 0.40, z = 2.23, p = .028), suicide-specific training (b = 0.82, SE = 0.29, z = 2.79, p = .006), and C-SSRS familiarity (b = 1.09, SE = 0.28, z = 3.88, p < .001) were significant predictors of perceived competence. Mental health training (b = -1.14, SE = 0.38, z = -2.97, p = .004) and suicide-specific training (b = 0.93, SE = 0.32, z = 2.93, p = .004) were significant predictors of comfort. Three themes were generated from the qualitative data: 1) Scarcity of mental health resources across healthcare settings fractures care pathways, 2) Overcrowding and understaffing in EDs threatens provider and patient safety, 3) Providers advocate for consistent training and integrated mental health specialists in EDs to fortify care. The findings highlighted system-wide barriers to effective mental health care and identified training and integration of mental health specialists in EDs as solutions. These insights support evaluation recommendations alongside the implementation of CMHA-BC’s Suicide Risk Reduction Framework.