Context

1-2% of all admissions to an Emergency Department (ED) are psychiatric-disease related. (Wyatt J, 2012 #13) This includes self-harm, depression, psychosis and other less common psychiatric conditions. These patients may present in a range of ways from a suicide attempt or overdose (OD), either deliberate or accidental, and from a florid first presentation of illness to a known ‘frequent attender’ with a chronic condition. Psychiatric patients can often be seen as challenging because of their complex histories and needs. Of all the psychiatric presentations to an ED, the most common reason for attendance is Self-Harm (SH). SH includes a wide range of activities, such as an intentional OD, cutting, poisoning using any substance or route of self-administration, etc.

In 2010/11 and 2011/12 there were more than 114,000 inpatient hospital admissions each year in England for intentional self-harm (SH), a 7% increase compared to 2009/2010, when there were just over 107,000 admissions, whoever 5,821 people aged 10 and over died by suicide in 2017, a decrease from 5,965 deaths in 2016.

In January 2013, MPs expressed concern at a rise in the number of suicides over the preceding years.

The highest suicide rate was in males aged 30 to 44 (23.5 deaths per 100,000 of the population). Worldwide, suicide is the tenth leading cause of death, with an annual mortality of 14.5 per 100,000 of the population. This equates to 1 death every 40 seconds globally.

People who SH are more likely than the general population to kill themselves. Associated with this, there is a general increase in morbidity and mortality. It is estimated that approximately 15-30% of patients who present with an episode of SH will SH again in that year. Of those who present to ED with an act of SH, 8-10% will successfully commit suicide in the same year.

Psychiatric presentations are an important group and junior doctors will invariably be the first doctor these patients meet. Therefore, it is important to have confidence in seeing these sometimes difficult, complex and challenging patients. A recent survey found that junior doctors felt they lacked the skills and confidence when assessing mental health patients.

This module has been designed with the RCEM curriculum in mind and as introduction to some of the key topics around mental health.