Two types of treatment

18 years ago I suffered burns on my hands, arms, chest and face in an accident. The burns were mostly superficial, 1st and 2nd degree, but the area was fairly large. After being treated in the emergency room, I spent the night at the home of my in laws. The next morning, having failed to drink enough water, I was dehydrated and I fainted. When I regained consciousness, we returned to the emergency room. I was a middle-aged, slightly overweight male who was experiencing lightheadedness. The response was nearly instant. I was plopped in a wheelchair, rushed to a treatment room, loaded on a gurney, fitted with leads to a heart monitor, given a pulse oximeter, hooked up to oxygen and within ten minutes of arriving at the emergency room there was a cardiologist at my bedside. I remembered the quick response and care at the end of September when my wife was admitted to the hospital in AFib. We didn’t have to wait in the waiting room. We were rushed into a treatment room and quickly began to receive life-saving treatment.

If you have symptoms of heart disease and arrive at an emergency room they don’t mess around. They also have all of the necessary emergency equipment and personnel with special training to respond to your condition. You get to see a doctor who has extensive specialized training in the treatment of heart disease. There are crash carts filled with all of the equipment and medicines needed to make a quick response to a heart attack.

There are a few simple questions which emergency rooms and hospital triage departments ask to determine a person’s risk of heart attack. As soon as they have a general sense that a heart attack may have occurred or might be about to occur they know exactly how to respond.

The response stands in stark contrast to another experience I have had in a hospital emergency room. I was with a person who was experiencing thoughts of suicide. In fact he was so suicidal that I didn’t dare leave him alone. I accompanied him to the emergency room because I didn’t know where else to obtain help and I knew I was up against a situation I couldn’t handle on my own. We were asked a few questions by an admitting clerk and then spent the next couple of hours waiting to be seen. The patient was taken to a triage area where blood pressure, temperature, and other vital signs were assessed. No one in that area asked any questions about mental health or thoughts of suicide. Eventually the patient was seen by an emergency room doctor who wrote a prescription before ordering the discharge of the patient.

Death from suicide in the United States has been on a steady climb for the last 20 years. The rate has increased 33% nation wide since 1999. We lose more than 47,000 people to suicide each year in our nation. The increase in the rate is steepest among teenagers. Suicide is now the leading cause of death among adolescents in our state.

Every patient who presents to a hospital emergency room receives a simple screening for heart disease. Blood pressure and blood oxygen are tested. The patient is asked about chest pain, light headedness and other common symptoms of heart disease. It would be even simpler to screen all emergency department admissions for suicidal thoughts. “Have you ever had thoughts of suicide or attempted to harm yourself?” That question isn’t a perfect screening question but a new study from the University of Massachusetts Medical School reported that the question increased the number of people who were treated by psychiatrists or given other suicide prevention resources increased by 90%. The effectiveness of simple suicide screening is so apparent that it is require of physicians who expect reimbursement from medicare for the treatment of patients.

Emergency rooms, however, are still not employing universal suicide screening procedures. The reason is not that they are ignorant of the latest research. The reason is not that they do not care. It is that they lack the resources to treat those suffering from suicidal ideation. While every emergency room is equipped with personnel and equipment to render life saving care to those suffering from heart disease. Most emergency rooms don’t have the resources to treat acute mental illness. They can get a cardiologist within minutes. They might not be able to get a psychiatrist within 24 hours.

Think about that for a minute. In South Dakota’s largest cities, the emergency rooms in our hospitals do not have the resources to treat the leading cause of death among our teenagers.

If a teen suffers from cancer, the community holds fund-raising and awareness events. If a teen is injured in an accident, we all go to work to insure the best possible treatment. When a teen suffers from mental illness, the stigma is so great that we don’t talk about it. The teen and the family are unsure if they can talk about their problem with their family, friends and church.

Emergency departments will tell you that they find it harder to get reimbursed for mental health treatment. Physical ailments result in payments. Mental health issues often result in the hospital having to swallow the cost.

I have decided that I will no longer support that stigma. I will not go silent or use euphemisms when talking about death from suicide or acute mental illness. When we lose members of our community to suicide I refuse to be silent about the cause of death. When I officiate at a funeral, I treat mental illness as a fatal disease in the same way that I treat cancer or heart disease. I speak out loud.

And when I take someone to the emergency room, I will advocate for proper treatment and intervention. A simple two-day training program can equip people to make emergency interventions for suicidal thoughts and behavior. Every emergency room technician is trained in CPR, which often does not work. ASIST suicide prevention training has been shown to be nearly 80% effective. A simple safety plan of making sure the patient knows who to call when suicidal situations arise, including mental health providers and crisis lines; limiting access to lethal means such as guns or poisonous materials; and a few additional practical steps have been proven to be lifesaving measures.

We can do better. We can save lives.

Copyright (c) 2019 by Ted E. Huffman. I wrote this. If you would like to share it, please direct your friends to my web site. If you'd like permission to copy, please send me an email. Thanks!