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Covid-19 HSE Clinical Guidance and Evidence

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Clinical Pathway for people who self-harm or who have suicidal ideation

Clinical Pathway for people who self-harm or who have suicidal ideation (CD19-024 002 / 07.07.20)


Authors
  • Dr. Anne Jeffers, Clinical Lead
  • Dr. Amir Niazi NCAGL Mental Health
  • Ms. Rhona Jennings, Programme Manager

 

Purpose
  • To help reduce the spread of coronavirus (COVID-19) all patients should be encouraged to phone their GP or mental health service before they present to ED in line with public health guidance at www.hpsc.ie   
  • People who self-harm are a group with the highest risk of completing suicide. For this reason in 2013 a National Clinical Programme (NCP) was developed for the Assessment and Management of Patients who present to the Emergency Department following Self-Harm. Central to the Model of Care are 4 principles – that the person receives an empathic and compassionate response in a safe environment; they receive a biopsychosocial assessment and intervention from a mental health professional; their next of kin or supportive adult is involved at assessment and discharge; that they are followed up and linked to appropriate next care.
  • To help reduce the spread of coronavirus (COVID-19) all patients should be encouraged to phone their GP, or mental health service before they present for assessment. For people who self-harm or have suicidal ideation key to management is ensuring the person receives a biopsychosocial assessment, with the person’s permission family members are included in the assessment and discharge planning and a management plan addresses safety issues and linkage to next care.

The following are offered as considerations and advice, and it is up to each service to use them as the situation allows.

  • Many people will be appropriately supported by phone discussion, text or email. Remote consulting via video link may be required for some and others will require face to face assessment.
  • If patients are referred to ED, early assessment by Mental Health (MH) staff will ensure the patient can move quickly through the ED. In some cases this could be through parallel assessments with ED staff, and in other cases the MH could consider seeing the patient immediately following triage. In some cases this assessment could be by phone or video link.  Discussion with ED staff as early as possible will support this.
  • Each service identifies the optimal use and placement of video consultation facility.
  • Each service identifies a suitable place for face to face assessments. In some cases this will be in the ED, ensuring patient and staff safety. In others it will be the Department of Psychiatry, or a community facility and in many a mixture of all.
  • Following assessment a clear management plan identifying the patient safety and route to next care should be well documented.
  • Information on CrisisText Lines Text YMH to 086 1800 280 or TEXT 50808 to text with a trained and supervised volunteers, or Samaritans, 116123 should be provided.
  • The use of a follow up phone call to the patient within 24 hours of assessment has been shown to have benefit. This call would review safety planning and repeat advice or information.
  • Remote prescribing: The clinician can phone through prescriptions to the patient’s pharmacy. The Pharmaceutical Society of Ireland has issued guidelines for pharmacists in supplying medicines in Emergency situations. Where the emergency supply is made at the request of a prescriber (registered medical practitioner, registered dentist or registered nurse prescriber) the pharmacist must be satisfied that the prescriber is, by reason of an emergency, not in a position to provide the prescription immediately. The prescriber undertakes to provide the prescription within 72 hours, and so it can be written and posted to the pharmacy.

Pathway for Care for People Who have Self-Harmed or are Suicidal
 

024                                                    


Pathway once a person is referred to a mental health service
  • MH Services provides a Master phone line for GPs and patients to access. 8am – 8pm this is staffed by CNS, or HSCP. 8pm-8 am this is staffed by NCHD and a staff nurse.
  • A MH professional provides telephone triage; following discussion with the patient identifies safety measures and immediate next care, including phone link to CMHT, or phone link to community support.
  • CMHT- provides a phone link that is staffed during working hours. The MH professional staffing the phone line can ensure urgent and emergency assessments can be provided. (This avoids the delay created by the practice of all referrals, including those that are urgent, being sent to a weekly team meeting)

Health Library Ireland, Health Service Executive. Dr. Steevens' Hospital, Dublin 8. Tel: 01-6352555/8. Email: hli@hse.ie

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