Semes opens the way to a code of hope in suicide prevention that activates radar in the emergency room

The COVID-19 pandemic has skyrocketed the number of patients in hospital emergencies with mental health pathologies and suicide attempts. It is estimated that the increase is around 30 percent, although it is still early to know the definitive impact, explains to GM Iria Miguéns, member of the Spanish Emergency Medicine (SEMES) and coordinator of the Depression and Suicide Working Group in Urgencies and Emergencies Hospitalarias, an initiative of the scientific society together with Fundamed that has the collaboration of Janssen.

SEMES has just presented the results of the report of this working group which, according to the entity's president, Manuel Vázquez Lima, may be the first step towards a Code of Hope aimed at suicide prevention, in line with other protocols promoted by society such as the Íctus Code or the Heart Code, with extensive experience and excellent results.

“In emergencies we are time-dependent. Based on this work, I invite you to develop a Code of Hope that perfectly defines the care process, procedures, indicators, measures, and follow-up in urgent care for suicide", the spokesperson states.

In this sense, Vázquez Lima emphasizes that emergency services are available in any circumstance and place. “We are committed to this project to provide initial support in suicide attempts, to carry out the necessary stabilization and offer key support and training to the patient and the family. In short, to act as a catalyst for subsequent assessment with other basic collaborators in the Mental Health Units”, he remarks.

The working group set up within this scientific society is made up of emergency physicians, psychiatrists, family doctors, health managers and patient representatives, who have analyzed strengths and weaknesses in urgent hospital care at these patients. Its coordinator, Iria Miguéns, reviews the main conclusions of this report without losing sight of the fact that the objective is that the measures can be implemented as soon as possible for the benefit of these patients.

Warning signs

The group has identified eight points to improve this care. The first of them refers to warning signs. At this point, Miguens highlights that “the first step is to raise awareness among the population and the health workers themselves. Nobody thinks that a heart attack is a weakness, but mental pathology is”.

With regard to the approach, the coordinator indicates that it is necessary to have an adequate infrastructure. “They are special patients and need special attention. The family, the immediate environment, must be integrated into these humanized spaces, not just the patient”, he remarks.

Another key point is the lack of training in mental health, an aspect in which this scientific society is committed to advancing, for the sake of excellent care.

In the same vein, experts agree on the need to improve the detection of patients in vulnerable situations. Miguéns points to young people in a context like the current one. "In our services, consultations by young people for drugs of abuse, suicide attempts, depressive symptoms, etc., have grown in a population that has a whole future ahead of it," he explains. “Our commitment to the young population has to be firm and we have to implement these measures now in this vulnerable population. We refuse to stigmatize a population that has suffered collateral damage from the pandemic," he says.

Another basic aspect is that the services can count on clinical practice guidelines that guide their work effectively. "The protocols have to be approved, the professionals have to have training and information for this approach," he points out.

Experts have also discussed the role of the media. In this line, Miguéns points out that it is necessary to carry out joint work and learning by both parties. The coordinator insists that you have to work on a common strategy to communicate properly. “There is a lot to contribute from everyone. Today we know that it is not wrong to talk about suicide but how it is done ”, he warns.

The last point focuses on the mental health of emergency health professionals. The spokeswoman acknowledges that they are tired and need help and recognition. In this sense, it invites the Ministry of Health to reflect on why it is not fulfilling its commitment to create an emergency specialty that allows them to carry out their work with the utmost excellence. Despite the fatigue, he points out that the pandemic fatigue of the professionals does not compromise the assistance in the emergency services

Mental Health Nurses

The president of the Psychiatry and Mental Health Foundation, Ana González-Pinto, is one of the members of this working group. From the perspective of her specialty, she defends the need to work in a connected way, not only in the clinical field, but also from the social point of view. “During the pandemic, it has been shown that the presence of a mental health nurse in the emergency room greatly improves care in part due to this coordination. There are several experiences in Galdakano, at the Gregorio Marañón Hospital, they are very positive experiences and we recommend it” he warns.

According to his vision, liaison nursing between hospital Emergencies and Mental Health centers is also important. The specialist stresses that in the same way that speed is essential in sepsis or heart attack, it is also essential in suicide attempts.

“Once a person has made a suicide attempt, it is essential to get an early appointment with a nurse and a psychiatrist. For this, resources are needed, although the situation is very uneven between communities, ”she explains. After this attempt, resources such as health advice are also useful to achieve adherence to treatment. González-Pinto explains that some communities incorporate this device through nursing professionals who, after hospital discharge, are in charge of calling the patient to ask how they are.

Likewise, the specialist insists that we must not forget that mental illness has a biological, psychological and social origin and there are environmental risk factors. “It is important that people hospitalized for suicide have prompt health and social care when they go home. There are associations and a network of social resources that should prioritize those people at risk of death”, he warns.

As reflected in the conclusions of the working group advanced by the coordinator, González-Pinto emphasizes the need for prevention from the school environment. In this sense, she highlights several European projects, such as UpRight, through which improvement in the resilience of young people is observed, reinforcing the role of education. The psychiatrist recalls that 50 percent of mental disorders begin in childhood. "It is time to act and the best treatment is prevention," he says.

Emergency, the starting point

From the perspective of the survivors, and according to the words of Cecilia Borrás, president and founder of 'After Suicide-Survivor Association', there is already a need of a change in care, partly as a consequence of the wear and tear caused by the pandemic.

Borrás recalls that in many cases the starting point for suicide is going to the emergency room: “That starting point must be vital. It's very important. What the professional treating us says or how it says may or may not increase the taboo”.

The spokesperson understands that the tour changes completely based on that first experience. "If those who go to the emergency room (with an autolytic intent) find a professional with empathy who approaches their case, provides them with a resource and makes them feel cared for, it can help change their idea that "nobody matters." . "This first contact can deeply mark us, hence the importance of this Code of Hope",

Similarly, Borrás stresses the need to "optimize all the resources in progress and reinforce the analysis of weaknesses, such as training in the detection of the first symptoms." "Training and awareness should cover all service professionals, from the emergency physician to the orderly... In suicide, sometimes the verbalization goes unnoticed and you have to be attentive to this sign," he says.

In any case, the radius of action in training to detect risk goes beyond the Emergency Department in the conclusions of this working group, which propose extrapolating it to all areas, even beyond healthcare, such as the educational environment and social terrain. Basic training to activate a social radar that can help save lives.

The ER specialty, part of the solution

The historical claim of the group, the ER specialty, has also been on the table with the background of improving care for people with mental disorders. The president of SEMES, Manuel Vázque Lima, recalled that care for these patients is on the map of competences as emergency physicians at a European level.

“In our European curriculum we dedicate a wide area of ​​training to all behavioral disorders and we would like to apply it in its entirety in Spain. Spain is one of the three countries that does not have this situation regulated throughout Europe, it is time to solve this anachronism ”, he warns.

As he has detailed, in this training curriculum around six months are devoted to the study of behavioral disorders, which even appears in the very definition of the specialty, which includes care for urgent and emerging disorders, including behavioral ones. “It is one of the few specialties that specifically includes it,” she warns.

Things change “if a professional has comprehensive training and part of their training is based on perfectly attending to and managing the Esperanza Code, because they have acquired it during their training as a resident. When he arrives at the service, he is a fully competent person to deal with a suicide attempt, depression or any other behavioral disorder ”.

In the same vein, Iria Miguéns questions that Spain does not have the specialty, even more so after having promised it from the Ministry of Health. In her opinion, it implies a lack of safety for patients, which is why she advocates working on it and claiming it as a right for patients.

“We are constantly indebted to our patients. We want to work on excellence, ”she concludes.