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Erica Green, MA, DrPH(c)
University of Illinois Chicago Doctoral Candidate
Crisis Counselor at Resurrection & Provena Network Hospitals
Clinical Therapist, Ro'derica Verde Health
Often crisis hotline workers are aware of strategies to assist callers with suicidal ideation to the hospital, yet are
unfamiliar with the psychiatric process, procedures and disposition criteria upon entering the emergency room.
This presentation will cover three main areas. First, it will begin with the intake process and a brief overview of
standard medical practice of the leading suicide attempt methods (i.e. overdose, wrist lacerations, and major
falls). Then it will cover Mini Mental Status Exam (MMSE) questioning, and understanding laboratory results.
Then finally, there will be discussion of what criterion denotes inpatient psychiatric hospitalization versus less
restrictive outpatient therapies.
There are various portals into the emergency department (ED): by way of self, family friend, EMS (ambulance/
fire department), or police department. Patients brought in by EMS, PD or those in a more critical state will be
seen sooner by emergency department than those arriving by private transport. Depending on severity of the
injury/illness, the admit worker or the triage nurse will be the first point of contact. Less severe cases go to
admissions where basic demographics and funding information is collected. More life threatening cases go
directly to the triage nurse where baseline vitals and questioning of intent behind suspicious injury or illness begins.
What questions are usually selected from the MMSE? What sights, sounds, and smells are factored into the ED
psychiatric evaluation? The assessment begins with general inquiry about activities of daily living (ADL), any
life stressors, as well as eating and sleeping habits. Next line of questioning involves whether it was a suicide
attempt, any previous attempts including methods, problems with delusions, hallucinations, number of
psychiatric hospitalizations, and substance use history. Lab results including toxicology, chemistry, CBC, and
UCG often can confirm or deny some of the patient report. The bulk of this presentation will focus on
integration of this data which becomes essential for patient disposition once the medical condition has stabilized.
Do results indicate the patient is at risk of harm of self, others or cannot care for basic needs? Is the patient
over 18 years of age? Yes, to any of these demonstrate a need for inpatient hospitalization. Documentation
including petitions and certifications will be covered as well as criterion for less restrictive referrals and resources.
The hospitalization process can be daunting to not only the patient but the entire crisis team. This presentation
will aim to clarify what is to be expected when the patient enters the local hospital emergency department and
increase continuity of care. Questions about what can be expected within a psychiatric facility, including
programming, can also be answered by this presenter.
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