Association of Characteristics of Psychiatrists With Use of Telemental Health Visits in the Medicare Population

Emergency departments most commonly assessed patients who present with self-harm for current suicidal intent/plans (2156 [97.6%]), past suicidal thoughts/behaviors (1989 [90.6%]), and access to lethal means (1708 [77.7%]) (Figure).Provision of individual safety planning elements ranged from 24.8% (n = 492) to 79.2% (n = 1710), with 2 of 6 elements being routinely provided more than 50% of the time: lists of professionals or agencies to contact in a crisis (1710 [79.2%]) and helping patients to recognize warning signs of suicide (1075 [52.2%]).Only 15.3% (n = 342) routinely provided all recommended safety planning elements.There were no significant differences in emergency self-harm management practices by urban/rural status, mental health staff availability, or hospital volume.However, EDs associated with teaching hospitals were significantly more likely than EDs affiliated with nonteaching hospitals to provide professional contact lists (791 [86.5%] vs 909 [73.7%];P = .004)(Table ).Discussion | Most EDs in the United States routinely assess patients who present with deliberate self-harm for suicidal thoughts/ behaviors and access to lethal means, but relatively few routinely act to provide basic aspects of safety planning, such as creating individualized plans to restrict access to lethal means, helping patients to use internal coping strategies, or accessing available social supports/activities.Emerging research indicates that safety planning in combination with structured telephone follow-up can significantly reduce suicidal behaviors after ED discharge compared with usual care.6 Because provision of these services in our study was largely independent of ED characteristics, there are widespread opportunities for improvement.Study limitations include use of self-report rather than an audit, the possibility that our ED sample may not generalize to all US EDs, and an inability to know whether social workers have mental health specialty training or which professionals provide the services.The study also was not designed to assess the effect of severity of the self-harm incident or recognition of a mental disorder in the ED on self-harm management practices.Future research should evaluate whether specific aspects of emergency management of deliberate selfharm lower the risk of repeat self-harm and suicide.