title: Experiences of substance-using suicidal males who present frequently to the emergency department.
abstract: OBJECTIVE
  This qualitative study investigated the repeated use of the emergency department (ED) by men with a history of suicidal behaviour and substance abuse to understand the needs and barriers to care for this high-risk group. Identification of common themes from interviews with patients and health care workers can serve as a basis for improved ED-based interventions.
  
  
  METHODS
  Using semistructured interviews, patients, ED staff and family physicians were asked about needs of the aformentioned group. Twenty-five patients were interviewed and completed questionnaires regarding their substance use, aggression, parasuicidal behaviour, alexithymia and childhood trauma. In addition, 27 staff members were interviewed. Interviews were tape-recorded, transcribed and qualitatively analyzed using an iterative coding process.
  
  
  RESULTS
  Of the 25 patients, 23 (96%) had a mood or anxiety disorder and 18 (75%) had borderline personality disorder. One-half of the patients scored high and another quarter scored moderate on alexithymia testing. The ED was viewed as a last resort despite seeking help. Frustration was felt by both patients and staff regarding difficult communication, especially during an acute crisis.
  
  
  CONCLUSIONS
  The ED plays an important role in the provision of care for men with recurrent suicidal behaviour and substance abuse. Some of the diagnoses and problems faced by these patients are beyond the purview of the ED; however, staff can identify mutual goals for crisis interventions, allow for frequent communication and seek to de-escalate situations through the validation of the stress patients are experiencing.
authors.affiliation: Emergency Department, St. Michael's Hospital, University of Toronto, Toronto, Ontario. spencej@smh.toronto.on.ca
authors.forename: Julia M
authors.initials: JM
authors.lastname: Spence
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Bergmans
authors.forename: Carol
authors.initials: C
authors.lastname: Strike
authors.forename: Paul S
authors.initials: PS
authors.lastname: Links
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Ball
authors.forename: Anne E
authors.initials: AE
authors.lastname: Rhodes
authors.forename: William J
authors.initials: WJ
authors.lastname: Watson
authors.forename: Rahel
authors.initials: R
authors.lastname: Eynan
authors.forename: Claire
authors.initials: C
authors.lastname: Rufo
mesh_terms: D000328:Adult; D000465:Algorithms; D003419:Crisis Intervention; D004636:Emergency Service, Hospital; D006801:Humans; D008297:Male; D020380:Needs Assessment; D009864:Ontario; D012008:Recurrence; D016728:Self-Injurious Behavior / Q000628:therapy; D019966:Substance-Related Disorders / Q000523:psychology*; D000092864:Suicide Prevention