The following article is part of conference coverage from the 2019 American Psychiatric Association Annual Meeting (APA 2019) in San Francisco, CA. Psychiatry Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in psychiatry. Check back for the latest news from APA 2019.


SAN FRANCISCO —In a addressing the challenges and importance of identifying individuals at risk of self-harm, presenters at the American Psychiatric Association’s Annual Meeting, held May 18 to 22, 2019, in San Francisco, California, pointed out the dangers presented by emergency pull cords for patients with suicidal intent.

In the United States, suicide now ranks as the 10th leading cause of death. A key step in psychiatric evaluations involves safety assessments focusing on recognizing signs of suicide risk so that increased safety measures can be taken in the hospital setting. Presenters discussed the case of a 34-year-old man with a history of depression and cocaine, cannabis, methamphetamine, and over-the-counter stimulant abuse who presented at a medical emergency department with agitation and suicidal thoughts after a several days long drug binge.

The man was guarded upon arrival, but then became disruptive and unable to be redirected, so he was chemically sedated. He was admitted to the hospital, placed under surveillance with a patient attendant and video monitoring, and the psychiatric department was consulted.


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After the initial intoxication resolved, the patient denied being suicidal and expressed a motivation to seek addiction treatment at a residential rehab following hospitalization. Several days later, he became disruptive and anxious again and began to demand discharge. Soon after his status was changed to involuntary, the patient barricaded himself in the bathroom and tried to hang himself using the emergency pull cord. The suicide attempt was interrupted and he was transferred to inpatient psychiatry.

The presenters discussed the balance between admitting high-risk individuals to treat and stabilize the underlying causes of suicidality and being certain that hospital admission will, in fact, decrease the risk of mortality.

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According to the presenters, “The Joint Commission assembled a panel in 2017 to provide guidance on adequate safeguards to prevent suicide…. These measures include decreasing potential ligature attachment points, removing potential methods of self-harm from the setting, and monitoring closely for the risks that cannot be fully eliminated from the facility.” They continued that while the Joint Commission stated that 75% of reported attempted inpatient suicides are by hanging, they did not list data for use of the emergency pull cord.

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Reference

Bryant C, Wintermeyer K, Alhajji L, Padilla VL, Sabbag SA. Suicide prevention in health care settings: an emergency pull cord creates the emergency. Poster presented at: Poster presented at: American Psychiatric Association Annual Meeting; May 18-22, 2019; San Francisco, CA. Abstract 102.