Clinical pathways for suicidality in emergency settings: a public health priorityKay Wilhelm A B D , Viola Korczak B , Tad Tietze A B and Prasuna Reddy B C
A School of Psychiatry, Faculty of Medicine, University of New South Wales, Randwick, NSW 2031, Australia.
C School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia. Email: firstname.lastname@example.org
D Corresponding author. Email email@example.com
Australian Health Review - http://dx.doi.org/10.1071/AH16008
Submitted: 1 February 2016 Accepted: 1 May 2016 Published online: 23 June 2016
Rates of self-harm in Australia are increasing and constitute a concerning public health issue. Although there are standard treatment pathways for physical complaints, such as headache, abdominal pain and chest pain, in Emergency Medicine, there is no national pathway for self-harm or other psychiatric conditions that present to the emergency department. Herein we outline the difference between clinical practice guidelines and clinical pathways, discuss pathways we have identified on self-harm in Australia and overseas and discuss their applicability to the Australian context and the next steps forward in addressing this public health issue.
Additional keyword: emergency department.
References Australian Government Department of Health. Mental health of Australians 2: suicidality. 2009. Available at: http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-m-mhaust2-toc~mental-pubs-m-mhaust2-hig~mental-pubs-m-mhaust2-hig-sui [verified 17 December 2015].
 Australian Bureau of Statistics. Causes of death, 2014. 2016. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/Previousproducts/78FC28EE32C91EC3CA257B2E000D75C3?opendocument [verified 16 May 2016].
 Anderson M. Waiting for harm: deliberate self-harm and suicide in young people: a review of the literature. J Psychiatr Ment Health Nurs 1999; 6 91–100.
| Waiting for harm: deliberate self-harm and suicide in young people: a review of the literature.CrossRef | 1:STN:280:DyaK1MzosVGgsw%3D%3D&md5=1fff965283e9cc9a17b25a5043e6305eCAS | 10455619PubMed |
 Fortune SA, Hawton K. Suicide and deliberate self-harm in children and adolescents. Paediatr Child Health 2007; 17 443–7.
| Suicide and deliberate self-harm in children and adolescents.CrossRef |
 Tsai MH, Chen YH, Chen CD, Hsiao CY, Chien CH. Deliberate self-harm by Taiwanese adolescents. Acta Paediatr 2011; 100 e223–6.
| Deliberate self-harm by Taiwanese adolescents.CrossRef | 21575057PubMed |
 Wan YH, Hu CL, Hao JH, Sun Y, Tao FB. Deliberate self-harm behaviors in Chinese adolescents and young adults. Eur Child Adolesc Psychiatry 2011; 20 517–25.
| Deliberate self-harm behaviors in Chinese adolescents and young adults.CrossRef | 21866416PubMed |
 Mahadevan S, Hawton K, Casey D. Deliberate self-harm in Oxford University students, 1993–2005: a descriptive and case-control study. Soc Psychiatry Psychiatr Epidemiol 2010; 45 211–9.
| Deliberate self-harm in Oxford University students, 1993–2005: a descriptive and case-control study.CrossRef | 19396386PubMed |
 Haw C, Hawton K. Life problems and deliberate self-harm: associations with gender, age, suicidal intent and psychiatric and personality disorder. J Affect Disord 2008; 109 139–48.
| Life problems and deliberate self-harm: associations with gender, age, suicidal intent and psychiatric and personality disorder.CrossRef | 18221789PubMed |
 Hawton K. Deliberate self-harm. Medicine 2004; 32 38–42.
| Deliberate self-harm.CrossRef |
 Ryan CJ, Large M, Gribble R, Macfarlane M, Ilchef R, Tietze T. Assessing and managing suicidal patients in the emergency department. Australas Psychiatry 2015; 23 513–16.
| Assessing and managing suicidal patients in the emergency department.CrossRef | 26224697PubMed |
 Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Deliberate Self-harm Australian and New Zealand clinical practice guidelines for the management of adult deliberate self-harm. Aust N Z J Psychiatry 2004; 38 868–84.
| Australian and New Zealand clinical practice guidelines for the management of adult deliberate self-harm.CrossRef | 15555020PubMed |
 National Collaborating Centre for Mental Health. Self-harm: the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. National Clinical Practice Guideline Number 16. London: Gaskell & British Psychological Society; 2004.
 National Institute for Heath and Care Excellence (NICE). Self-harm: the NICE guideline on longer term management. Guideline Number 133. London: NICE; 2012.
 Cheah TS. Clinical pathways: the new paradigm in healthcare? Med J Malaya 1998; 53 87–96.
| 1:STN:280:DC%2BD3cvjtVGqsQ%3D%3D&md5=cee665d5fb62a83201248f85646087c1CAS | 10968144PubMed |
 Kinsman L, Rotter T, James E, Snow P, Willis J. What is a clinical pathway? Development of a definition to inform the debate. BMC Med 2010; 8 31
| What is a clinical pathway? Development of a definition to inform the debate.CrossRef | 20507550PubMed |
 Rotter T, Kinsman L, James E, Machotta A, Willis J, Snow P, Kugler J. The effects of clinical pathways on professional practice, patient outcomes, length of stay, and hospital costs: Cochrane systematic review and meta-analysis. Eval Health Prof 2012; 35 3–27.
| The effects of clinical pathways on professional practice, patient outcomes, length of stay, and hospital costs: Cochrane systematic review and meta-analysis.CrossRef | 21613244PubMed |
 Coffey RJ, Richards JS, Remmert CS, LeRoy SS, Schoville RR, Baldwin PJ. An introduction to critical paths. Qual Manag Health Care 2005; 14 46–55.
| An introduction to critical paths.CrossRef | 15739581PubMed |
 Whyte IM, Dawson AH, Buckley NA, Carter GL, Levey CM. Health care. A model for the management of self-poisoning. Med J Aust 1997; 167 142–6.
| 1:STN:280:DyaK2svhsVGktA%3D%3D&md5=0f38fd46cd45fb0a21af38c03d9aea24CAS | 9269269PubMed |
 Children’s Trust Partnership Hertfordshire. Self-harm and suicidal behaviour: a guide for staff working with children and young people in Hertfordshire. 2010. Available at: http://www.thegrid.org.uk/leadership/programmes/conferences/documents_safeguarding/selfharm_suicide_guidance.pdf, page 11 [verified 17 May 2016].
 Derby City Council. Multi-agency self-harm protocol. 2010. Available at: http://www.derby.gov.uk/media/derbycitycouncil/contentassets/documents/safeguardingchildreninformation/SelfHarmBooklet.pdf, page 12 [verified 16 May 2016].
 Lancashire NHS Trust. Lancashire Care self-harm pathway. 2009. Available at: https://www.lancashirecare.nhs.uk/media/Clinical%20Care%20Pathways/Self%20Harm%20Pathway%20Full.pdf [verified 16 May 2016].
 Shropshire Safeguarding Children Board. Suicide prevention: care pathway for children and young people in Shropshire, page 21. 2013. Available at: https://shropshire.gov.uk/committee-services/documents/s1822/Appendix%20C%20V18%2004.03.14%20Self%20Harm%20Policy%20and%20Guidelines.pdf [verified 16 December 2015].
 Kripalani M, Nag S, Nag S, Gash A. Integrated care pathway for self-harm: our way forward. Emerg Med J 2010; 27 544–6.
| Integrated care pathway for self-harm: our way forward.CrossRef | 20584956PubMed |
 Steel M. A nurse-led pathway to treat self-harm injuries. Nurs Times 2015; 111 17–20.
| 26427255PubMed |
 Greyner B. An integrated step-down model of care: the Project Air strategy for personality disorders. Acparian 2015; 9 8–13.
 Wilhelm K, Finch A, Kotze B, Arnold K, McDonald G, Sternhell P, Hudson B. The Green Card Clinic: overview of a brief patient-centred intervention following deliberate self-harm. Australas Psychiatry 2007; 15 35–41.
| The Green Card Clinic: overview of a brief patient-centred intervention following deliberate self-harm.CrossRef | 17464632PubMed |
 Wilhelm K, Handley T, Reddy P. Exploring the validity of the Fantastic Lifestyle Checklist in an inner city population of people presenting with suicidal behaviours. Aust N Z J Psychiatry 2016; 50 128–34.
| Exploring the validity of the Fantastic Lifestyle Checklist in an inner city population of people presenting with suicidal behaviours.CrossRef | 26681263PubMed |
 Hawton K, Harriss L, Zahl D. Deaths from all causes in a long-term follow-up study of 11,583 deliberate self-harm patients. Psychol Med 2006; 36 397–405.
| Deaths from all causes in a long-term follow-up study of 11,583 deliberate self-harm patients.CrossRef | 1:STN:280:DC%2BD28%2FovVeitw%3D%3D&md5=a073b6ca60eec3ee2463a9db65396174CAS | 16403244PubMed |
 Mental Health and Drug and Alcohol Office. Mental health for Emergency Departments: a reference guide. Sydney: NSW Department of Health; 2009.
 NSW Health. Suicide risk assessment and management: Emergency Department. Sydney: NSW Health; 2004.
 Centre For Mental Health Policy. Guidelines for the management of patients with possible suicidal behaviour for NSW Health staff and staff in private hospital facilities. NSW Department of Health Circular 98/31. Sydney: Ministry of Health; 2016.
 Martin G, Swannell SV, Hazell PL, Harrison JE, Taylor AW. Self-injury in Australia: a community survey. Med J Aust 2010; 193 506–10.
| 21034383PubMed |