Suicidal patients sent to A

GPs are being forced to send suicidal patients to A&E units because of problems arranging urgent psychiatric reviews due to a labour shortage, new research has found.

In a study to identify the educational needs of GPs in the area of suicide and its prevention, doctors listed the practicalities of securing an urgent review by a consultant as a difficulty when caring for patients at risk of suicide.

Co-author of the study Dr Conor Geaney said the time taken to secure an urgent review within an over- stretched psychiatric service, could often vary from three to four days. This left GPs with no option but to send suicidal patients to A&E, he said.

Dr Geaney, of the Irish College of General Practitioners, and co-author Dr Daris Broomfield, of the Royal College of Surgeons in Ireland, also criticised the “very limited availability of counselling services for patients who cannot afford to attend privately”.

They said it was often difficult to arrange out-patient appointments. As a result, people who attempted suicide often failed to get any follow up psychiatric services.

Dr Geaney said doctors would like to see a psychotherapist attached to all primary care practices for even a half day a week, to cater for public patients who could not afford private counselling sessions.

“A lot of patients fall through the gaps and as a result do not receive the appropriate treatment,” Dr Geaney told Medicine Weekly.

Patients at risk of suicide often had to wait a number of weeks to get even an out-patient appointment, Dr Geaney said, “when ideally, it was needed urgently”.

Doctors were also concerned about patients being referred back to them by psychiatric hospitals if intoxicated.

“The risk of suicide is higher in patients expressing suicidal ideastion when drunk,” he said. Secretary of the Irish Association of Suicidology, Dr John Connolly, said there was no doubt but that there was a link between increased drinking levels and suicide.

He also said admitting suicidal patients through A&E was not uncommon.

“In certain hospitals, after 5pm, all admissions to the psychiatric unit come through A&E,” he said.

Emergency cases in Mayo, where Dr Connolly is based, were assessed immediately, he said, but “a lot of people who are depressed go to casualty themselves”.

Research officer for the National Suicide Review Group Derek Chambers said health boards were working on installing crisis nurses or psychiatric liaison nurses, attached to A&Es, but they were experiencing frustrations.

He said the biggest problem was risk assessment, because it was not an absolute science.

The majority of GPs surveyed called for an increase in the number of community psychiatric care nurses and more liaison between community psychiatric services and general practices.