The Washington Post - 12.11.2019

e6 ez ee the washington post.tuesday, november 12 , 2019

continue to follow this issue

closely.”

Doctors and health experts say

that mental health treatment is

severely underfunded and under-

staffed in hospitals across the

country. Patients coming into Ers

with mental health problems of-

ten sit for 24 hours or more

waiting to see a doctor. Some wait

for days and even weeks for a bed

in the psychiatric ward.

“If I have a patient with appen-

dicitis or a heart attack, I can get a

surgeon on the phone and get the

patient taken care of instantly,”

said Sandra Schneider, an emer-

gency physician and former pres-

ident of the ACEP. “But if some-

one came in trying [to] kill them-

selves, in many hospitals in the

country, t he only person available

is a psychiatric nurse or social

worker or behavioral specialist

on call that day. It’s not even a

doctor.”

mental health treatment in

Ers is often harder to get reim-

bursed for than physical ail-

ments, emergency doctors say.

And in some cases, hospitals end

up swallowing the cost.

Emergency physicians also

point to the litany of screenings

they do for other problems, such

as tobacco, alcohol use and do-

mestic violence. They say they

would need more time, money

and training to add suicide

screening.

“I happen to be a fan of screen-

ing, but the question is how do you

treat folks once you find out they

want to hurt themselves?” said

michael Wilson, an emergency d e-

partment physician and mental

health researcher a t the University

of Arkansas. “You can’t just screen

and send them out the door.”

As it is, he said, Er staff often

have to decide among bad op-

tions: Hospitalizing patients,

which can strain resources, or

discharging them with a sheet of

mental health clinics to call —

which might not be able to see

new patients for a month or even

longer.

“focusing on screening is a

little like worrying about the lawn

catching on fire when the house is

burning down,” Wilson said.

Boudreaux acknowledged such

concerns.

“There are real barriers to im-

plementation,” he said. “No one

denies that. But what’s the alter-

native? Would we rather not

know that people want to kill

themselves? Is i t better to just not

ask and not know?”

After spending the past decade

testing suicide screening in Ers

in seven states, Boudreaux said he

is convinced the approach is sav-

ing lives.

As p art of a $17 million federal-

ly funded study, Boudreaux and

other researchers at eight hospi-

tals found that adding screening

in Ers almost doubled the num-

ber of patients identified as hav-

ing suicidal thoughts or who had

attempted suicide in the past —

from 2.9 percent of adult patients

to 5.7 percent.

researchers also found that

combining screening with brief

telephone counseling after the

visit led to 30 percent fewer total

suicide attempts over the 52

weeks of follow-up, compared

with standard emergency depart-

ment care.

A different study last year —

based on treatment of 1,200 pa-

tients at five Veteran Affairs hos-

pitals — showed even a simple

intervention by Er staff can re-

duce the chances of future at-

tempts. By making a safety plan

with suicidal patients before dis-

charging them, Er staff reduced

their risk of suicidal behavior by

half.

The safety plans involved mak-

ing a list of people to call when

suicidal urges arise, including

mental health providers and cri-

sis lines, as well as coming up

with coping strategies and limit-

ing access to lethal means such as

guns or poisonous materials.

“A lot of times, patients don’t

seek further care other than what

they get in the emergency depart-

ment,” said Barbara Stanley, a

Columbia University psycholo-

gist who wrote the study. “This

may be the only time we have

with them. So the idea was let’s

give them something they can

walk away with, even it’s small.”

Suicide prevention groups and

emergency departments have

started to find common ground.

over the past year, for example,

emergency physicians have

worked with the American foun-

dation for Suicide Prevention to

develop a rapid suicide screening

and intervention tool called

ICAr2E, which they encourage

Ers to adopt voluntarily, to help

assess and manage suicidal pa-

tients.

“We took 31 studies on suicide

prevention in emergency depart-

ments and boiled it down to best

practices and steps,” Wilson said.

“Every emergency physician I

know got into this business to

save lives. The question is what

are the best ways to do that?”

Universal screenings are un-

likely to become widespread un-

less an accreditation authority

such as the Joint Commission

makes them mandatory, or if

funding for them were made

available, Er doctors and mental

health advocates said.

New funding, however, ap-

pears unlikely unless federal offi-

cials overseeing medicare and

medicaid were to introduce reim-

bursements, financial incentives

for safety planning or screening

in hospitals, or change the way

mental health treatment is fund-

ed in emergency departments, Er

officials and suicide prevention

advocates said.

officials at Centers for medi-

care and medicaid Services did

not respond to questions on

whether they are considering any

such change.

“The question is whether we as

a society a re willing to pay what it

takes to address the problems of

mental health,” Boudreaux said.

[email protected]

if you or someone you know needs

help, call the national suicide

prevention lifeline at 800-273-talK

(8255). You can also text a crisis

counselor by messaging the crisis

te xt line at 74 1741.

America’s suicide problem has
now reached crisis levels. Every
year since 1999, the country’s
suicide rate has increased, climb-
ing 33 percent in the past two
decades. more than 47,000 people
now kill themselves every year,
and more than a million attempt
to do so. Alarmingly, new analy-
ses show the increase has been
sharper in teenagers and adoles-
cents than any other age group.
Gun violence is intertwined with
the overall rise — nearly half of all
fatal suicides involve firearms.
Suicides now account for 60 per-
cent of America’s gun deaths.
Leading medical authorities
argue the United States could
reduce those skyrocketing rates
with a relatively simple solution
by screening for suicide in health
clinics and Ers.
Universal screening entails
asking everyone visiting a prima-
ry care clinic or Er whether they
are having suicidal thoughts, and
if so, following up with brief
interventions such as telephone
counseling and referrals for addi-
tional treatment.
The idea is endorsed by the
National Institute of mental
Health, which has poured mil-
lions of dollars into researching
the proposal and has tried to
persuade physician groups,
health-care companies and regu-
lators to support it. Suicide pre-
vention groups also have pushed
for widespread screening.
resistance has mainly come
from the hospital industry and
Er doctors and nurses, who say
they don’t h ave sufficient resourc-
es to deal with suicidal and men-
tally ill patients they’re already
aware of in their facilities — much
less additional ones who would
be identified by screenings. The
American College of Emergency
Physicians has come out against
the idea, for those same reasons.
The Joint Commission — which is
in charge of accrediting hospitals
and carries enormous influence
on their policies — has said that
screenings could be helpful but
has not made them mandatory.
In an email, the commission’s
Executive Vice President for
Health Care Quality Evaluation
David Baker explained that after
extensive consideration, his orga-
nization decided not to require
universal screening because re-
search showed screening alone
wasn’t e ffective when it isn’t c om-
bined with counseling and follow
up.
“A t this time, most [emergency
departments] are not able to pro-
vide this level of care,” Baker said.
“We would be willing to consider
an expansion of the screening
requirement in the future, and we

suicide from e1

Experts push ER screening to fight suicide crisis

adam glanzman for the Washington post

health News

CAPE CANAVERAL, FLA. — A
dozen bottles of fine french wine
arrived at the space station last
week, not for the astronauts, but
for science.
The red Bordeaux wine will
age for a year up there before
returning to Earth. researchers
will study how weightlessness
and space radiation affect the

aging process. The goal is to

develop new flavors and proper-

ties for the food industry.

The bottles flew up aboard a

Northrop G rumman capsule that

launched from Virginia o n Nov. 2

and arrived at the International

Space Station on Nov. 4. Each

bottle was packed in a metal

canister to prevent breakage.

Universities in Bordeaux,

france, and Bavaria, Germany,

are t aking part in the e xperiment

from Space Cargo Unlimited, a

Luxembourg start-up.

Winemaking uses both yeast

and bacteria, and involves chem-

ical processes, making wine ideal

for s pace study, said University o f

Erlangen-Nuremberg’s michael

Lebert, the experiment’s scientif-

ic director, in a company video.

The space-aged wine will be

compared to Bordeaux wine

aged on Earth. What’s left will go

to those who helped pay for the

research, according to a compa-

ny spokeswoman.

This is the first of six space

missions planned by the compa-

Space station gets fine French wine — but sorry, astronauts, it’s not for drinking

ny over the next three years

touching o n the future of agricul-

ture given our changing world.

“ This is a once-in-a-lifetime

adventure,” Nicolas Gaume, chief

executive and co-founder of

Space Cargo, said in a statement.

NASA is opening the space

station to more business oppor-

tunities like this and, eventually,

even private astronaut missions.

The Cygnus capsule that

pulled up to the space station last

week contains multiple commer-

cial ventures. Also on board: an

oven for baking chocolate chip

cookies, as well as samples of

carbon fiber used by Italy’s Lam-

borghini in its sports cars.

Budweiser has sent barley

seeds to the station, with an eye

to becoming the beverage of

choice on mars. In 2015, a Japa-

nese company known for its

whiskey and other alcoholic

drinks sent up samples. Scotch

also made a visit to space in

another experiment.

As for highflying wine cellars,

this isn’t the first. A french

astronaut took along a bottle of

wine aboard shuttle Discovery in

1985. The bottle remained cork-
      ed in orbit.
      The space station’s current
      crew includes three Americans,
      two russians and an Italian, who
      might have preferred a good
      chianti on board.
      — Associated Press

space cargo Unlimited/associated press

space cargo unlimited researchers prepare French wine for a trip

to the international space station last week. scientists will study

how weightlessness and space radiation affect the aging process of

the 12 bottles of Bordeaux.

“There are real barriers to

implementation” of mandatory

screening in emergency rooms,

edwin Boudreaux says. “No one

denies that. But what’s the

alternative? Would we rather

not know that people want to

kill themselves? is it better to

just not ask and not know?”

“At this time, most

[emergency

departments] are not

able to provide this level

of care.”

David Baker, executive vice

president for health care

quality evaluation at the Joint

commission, the group in charge

of accrediting hospitals

Inbox

inspirational

S0

12

0-

2x

1.5

washingtonpost .com/news/inspired-life

Find the inspirational,

helpful and humorous

in today’s news.

Delivered Saturdays.

Health Guide

For Advertising Contact

[email protected] | 202-334-6200

Deadline: Wed. at 12-noon (6 days prior)

ALEXANDER TECHNIQUE

Stock photo. Posed by model.

research study

This study looks at whether an approved depression

treatment called TMS (a type of non-invasive brain stimulation)

might also work to treat cocaine addiction.

All study participants will receive TMS therapy to see if it

works to help them stop using cocaine.

• Participants may earn up to $1,230


• Participation may include up to 15 study visits


• All study visits will take place in East Baltimore

Learn more:

1-866-START- NOW

ResearchStudies.DrugAbuse.gov

Are you struggling

with cocaine use?

Maybe we can help.

We need you for a

research studyif you:

• Are 18–60 years old


• Use cocaine or
  crack-cocaine and
  want to quit

ALEXANDER TECHNIQUE SLEEP DISORDER

Experiencing excessive

DAYTIME

SLEEPINESS?

• Are 18-65 years of age


• Have Narcolepsy Type 1

THE CENTER FOR SLEEP & WAKE

DISORDERS IS ACTIVELY SEEKING

QUALIFIED PARTICIPANTS WHO: 4 /+&*)%7$3+% ,+' 3&) $%. 8'$6)#

4 "85.: ')#$8). &).9-$3+% $%.

)!$&9%$3+%7 $8 %+ )!8'$ -+78

QUALIFIED PARTICIPANTS

MAY RECEIVE:

2, 7+1 :+5 &$: (5$#9,:

for a clinical research

785.:0

The Center for Sleep & Wake Disorders

Chevy Chase, MD / Friendship Heights Metro

Call:301-654-5665

[email protected]

SLEEP DISORDER