Author Question: Emergency Care of the Suicidal Patient

Riannon Asks:

I’d really appreciate your help in answering some questions. I’ve Googled as much as possible, and I just can’t seem to find answers for some things.

At one point in a play I’m writing, a character attempts suicide. His goal is not actually to die, but he does go through the process. What happens is that he’s very drunk and it’s a combination of probably alcohol poisoning and a lot of pills, something relatively accessible lying around the house, but potentially lethal in a high dose and then he calls 911 right afterwards.

So my questions are:
1. Would he be allowed to have visitors the next day? Essential for plot reasons.
2. Would visitors have to be family members or something or would friends/acquaintances be able to fudge their way in?
3. Before someone visits a patient, is the patient told that they’re coming and who they are? (I have very little knowledge of how hospitals work.)
4. How screwed up would he be physically?
5. Would he have to be committed to psych, and if so, when?
6. What could he have overdosed on?

Jordyn Says:

Hi Riannon!

Thanks so much for sending me your questions.

1. Would he be allowed visitors the next day? Depends on where he is at in the process. I’ll give you the process a patient goes through at our hospital, but you might need to adapt it if your play is located in a specific town, state, etc.

When a patient comes in with a suicide attempt, they are placed on 1:1 observation. The patient must be “medically cleared” before they can participate in a mental health evaluation. What that means is that they are no longer in danger medically from what they ingested AND that they are clear mentally to participate in the process. For instance, our patients would have to be below the legal limit for alcohol in order to participate. During the time of medical clearance and during the mental health evaluation (as for pediatrics parents are involved in the process) the patient is allowed to have visitors. A limited number. We try to keep it to two at a time and generally only immediate family.

If the patient is deemed to be a danger to themselves and does not voluntarily consent to treatment, then they are placed on an M1-Hold. This will have different names in different areas, but it is a legal document where the patient is involuntarily committed to a mental health institution for stabilization for about three days. Most mental health facilities will strictly limit visitors and may not let anyone visit during the initial 24-48 hours. Depends on the facility.

2. Could family/friends fudge their way in? I think I’ve mostly answered this above. If the patient is at a mental health hospital probably not without inside help. These are generally locked facilities that will keep a close eye on who is coming and going.

3. Is the patient notified of visitors? I can give you the ER answer and that is it depends. If the patient is unconscious then probably not. If the patient is conscious then we do want to inform the patient of who is there, but we would likely keep it to immediate family. We don’t want to inflame an already volatile situation so if the patient would become harmful to themselves or others then visitors are restricted. Pediatric patients will sometimes try and not have their parents visit, but parents are part of the process, so we encourage them to be at the bedside as long as the patient can be safe.

4. How screwed up would he be physically? Depends on a lot of factors. What he took. How much he took. And how long before he sought medical care.

5. Would he be committed to psych? If so, when? Yes, in this instance, he would be committed involuntarily if he did not agree to a voluntary admission. This would happen once he’s medically stable and after his mental health evaluation. Sometimes, patients may not be medically cleared for 12-24 hours (sometimes longer depending on the drug’s half life). Then we have to wait for an available mental health counselor which can take an additional 3-6 hours. Then waiting for placement could be another 3-24 hours. It can be a very lengthy process. Mental health beds are not that easy to find at times. Patients are held in the ER until they have a bed placement. It is also a requirement of our hospital that patients be transported by ambulance to their mental health facility and generally family members are not allowed to ride in the ambulance with them. This is a safety concern for the EMS crew.

6. What could he have overdosed on? This is really up to you as the author. Any drug can be toxic given in enough quantities and alcohol ingestion on top of that can make things much worse. Some of the more common medications most people have at home that can become easily toxic, in my opinion, would be acetaminophen (Tylenol), aspirin, and diphenhydramine (Benadryl).

Hope this helps and best of luck with your novel!

2 thoughts on “Author Question: Emergency Care of the Suicidal Patient

    • Hi Susan,

      A drug’s half life is the amount of time for 50% of the drug to be metabolized whereas a drug’s peak time is the amount of time for the patient to feel the drug’s full effects. We look at half time in relation to patients who intentionally or accidentally take an overdose of medications to guage how long they will likely be effected by the drug. Some medications have very LONG half lifes– like 8-24 hours so with longer half lifes– the more likely the patient will be sick for an extended amount of time.

      Like

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