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“Treat Them Like a Human Being…They are Somebody’s Somebody”: Providers’ Perspectives on Treating Patients in the Emergency Department After Self-Injurious Behavior

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Abstract

To understand ED providers’ perspective on how to best care for individuals who present to US emergency departments (EDs) following self-injurious behavior, purposive recruitment identified nursing directors, medical directors, and social workers (n = 34) for telephone interviews from 17 EDs. Responses and probes to “What is the single most important thing ED providers and staff can do for patients who present to the ED after self-harm?” were analyzed using directed content analysis approach. Qualitative analyses identified four themes: treat patients with respect and compassion; listen carefully and be willing to ask sensitive personal questions; provide appropriate care during mental health crises; connect patients with mental health care. Participants emphasized treating patients who present to the ED after self-injurious behavior with respect and empathy. Hospitals could incentivize provider mental health training, initiatives promoting patient-provider collaboration, and reimbursement strategies ensuring adequate staffing of providers with time to listen carefully.

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Acknowledgements

Miranda Pollock, MPH, was involved in coding and analyzing the qualitative data presented in this manuscript. Dr. Stephanie Doupnik reports salary support for suicide prevention research from NIMH (K23MH115162). Amaya Diana was involved in data collection and management.

Funding

This research was supported by grant 5R01-MH107452 from the National Institute of Mental Health (NIMH), National Institutes of Health (Marcus, Olfson, Multi-PIs).

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Authors and Affiliations

  1. School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104, USA

    Sara Wiesel Cullen & Steven C. Marcus

  2. Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, Children’s Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, USA

    Cadence F. Bowden & Stephanie K. Doupnik

  3. New York State Psychiatric Institute and Clinic and the Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA

    Mark Olfson

  4. Leonard Davis Institute of Health Economics, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104, USA

    Steven C. Marcus & Stephanie K. Doupnik

  5. Penn Center for Mental Health, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104, USA

    Steven C. Marcus

  6. Department of Emergency Medicine, The Ohio State University Wexner Medical Center, 751 Prior Hall 376 W 10th Ave, Columbus, OH, 43210, USA

    Jeffrey M. Caterino

  7. Graduate School of Social Service, Fordham University, 113 W. 60th St, #721-D, New York, NY, 10023, USA

    Abigail M. Ross

  8. Department of Pediatrics, University of Pennsylvania, 2716 South Street, Philadelphia, PA, 19146, USA

    Stephanie K. Doupnik

  9. Section of Community and Population Medicine, Louisiana State University Health Sciences Center – New Orleans School of Medicine, 533 Bolivar St., New Orleans, LA, 70117, USA

    Gala True

  10. South Central Mental Illness Research, Education, and Clinical Center, Southeast Louisiana Veterans Health Care System, 533 Bolivar St, New Orleans, LA, 70117, USA

    Gala True

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  1. Sara Wiesel Cullen
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  7. Stephanie K. Doupnik
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Contributions

All authors have sufficiently contributed to the manuscript and approved the final manuscript submitted here. Conceptualization: SCM, MO; Methodology: SCM, MO, GT, JMC, AMR, SKD; Formal analysis and investigation: GT, SWC, CFB; Writing – original draft preparation: SWC; Writing – review and editing: all study authors; Funding acquisition: SCM, MO; Supervision: GT. This manuscript has not been published previously.

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Correspondence to Sara Wiesel Cullen.

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Conflict of interest

Dr. Marcus reports receipt of consulting fees from Allergan, Alkermes, Johnson & Johnson, Sage, and Sunovion. Dr. Caterino owns stock in Motive Medical Intelligence. No financial disclosures were reported by the other authors of this paper.

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Table 2 Qualitative themes and exemplar quotes
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Cullen, S.W., Bowden, C.F., Olfson, M. et al. “Treat Them Like a Human Being…They are Somebody’s Somebody”: Providers’ Perspectives on Treating Patients in the Emergency Department After Self-Injurious Behavior. Community Ment Health J 59, 253–265 (2023). https://doi.org/10.1007/s10597-022-01003-y

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