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Published Online: 27 March 2024

Impact of Emergency Department Safety Planning on 30-Day Mental Health Service Use

Abstract

Objective:

The aim of this study was to examine the association between emergency department (ED) safety planning and subsequent use of mental health care among individuals treated in the ED for suicidal behavior and to determine whether subsequent use differed by patients’ receipt of recent mental health care.

Methods:

Data from 130 hospitals, derived from a 2017–2018 national hospital survey, were paired with national health insurance data from 2,328 patients with suicidal behavior treated in the EDs of these hospitals. Rates of ED readmission, inpatient admission, and outpatient mental health follow-up care in the 30 days after discharge from the index ED visit were examined.

Results:

During the 30 days after discharge from the index visit, readmissions to the ED (18% vs. 22%) and inpatient admissions (12% vs. 15%) for suicidal behavior or other mental health issues were significantly lower among patients treated in the EDs that routinely implemented safety planning, compared with those that did not, respectively. Among patients who had not received mental health care within 30 days before the index visit, those treated in an ED implementing routine safety planning were about half as likely (adjusted risk ratio=0.60) as those treated in an ED without such planning to have an ED readmission.

Conclusions:

Safety planning was associated with fewer subsequent ED and inpatient admissions among patients treated in the ED for suicidal behavior. The authors recommend that safety planning be universally implemented in EDs and included in routine outpatient care.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 528 - 533
PubMed: 38532689

History

Received: 18 April 2023
Revision received: 22 September 2023
Revision received: 7 November 2023
Accepted: 9 November 2023
Published online: 27 March 2024
Published in print: June 01, 2024

Keywords

  1. Suicide and self-destructive behavior
  2. Mental health systems
  3. Emergency health care
  4. Safety Planning Intervention

Authors

Details

Sara Wiesel Cullen, Ph.D., M.S.W. [email protected]
School of Social Policy & Practice (Cullen, Marcus) and Department of Psychiatry, Perelman School of Medicine (Xie, Marcus), University of Pennsylvania, Philadelphia; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Olfson).
Mark Olfson, M.D., M.P.H.
School of Social Policy & Practice (Cullen, Marcus) and Department of Psychiatry, Perelman School of Medicine (Xie, Marcus), University of Pennsylvania, Philadelphia; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Olfson).
Ming Xie, M.S.
School of Social Policy & Practice (Cullen, Marcus) and Department of Psychiatry, Perelman School of Medicine (Xie, Marcus), University of Pennsylvania, Philadelphia; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Olfson).
Steven C. Marcus, Ph.D.
School of Social Policy & Practice (Cullen, Marcus) and Department of Psychiatry, Perelman School of Medicine (Xie, Marcus), University of Pennsylvania, Philadelphia; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Olfson).

Notes

Send correspondence to Dr. Cullen ([email protected]).

Competing Interests

Dr. Marcus reports receiving consulting fees from Janssen Pharmaceuticals. The other authors report no financial relationships with commercial interests.

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