- Do not leave the patient alone.
- Place the patient in as safe an environment as possible.
- Tell the patient that you want him or her to be seen by a psychiatrist as soon as possible.
- Call for an urgent consultation.
- Give the emergency room physician or the on-call psychiatrist as much information as you can, including any history of psychiatric disorders, suicide attempts, family history of suicide attempts, current stressors, current medical conditions and medications. Whenever possible, send a brief note. For example:
- This 45-year-old male patient has a history of serious unipolar depression with one suicide attempt in the past. He is currently going through a difficult divorce, is depressed and expressing hopelessness, suicidal intent, with a plan to overdose on his antidepressants. He is medically well except for mild hypertension. His current medications are: hydrochlorothiazide 25 mg per day, and sertraline 150 mg per day.
- Have your staff call a family member or friend of the patient.
If the Patient is Cooperative and Wants Help
A patient who is cooperative can be transferred to hospital as a voluntary patient with a responsible family member or friend. Some emergency rooms will expect you to have done a basic “medical clearance.” This usually involves asking the patient about drug ingestion, and doing vitals and a basic neurological examination.
Let the emergency room know when the patient leaves your office and when they should expect the patient to arrive. Ask to be called if the patient does not arrive within a reasonable time. If the patient does not arrive, call the patient’s home. If you cannot locate the patient, call police and tell them your concerns, and ask them to apprehend and take the patient to the nearest emergency room. Familiarize yourself with your jurisdiction’s mental health legislation so you will be able to use its powers appropriately to help your patients.
If the Patient is Not Cooperative
Tell a patient who refuses to go to the emergency room that you are very concerned and that you are obligated by law to ensure the patient’s safety. (Each province and territory has mental health legislation that deals with the physician’s powers and responsibilities; you can find this information online by searching “Mental Health Act” plus the name of the province or territory.) Call police and request that they take the patient to the nearest emergency room. Be prepared to give a description if the patient leaves your office. Do not try to physically stop the patient.