Survey of California emergency departments about practices for management of suicidal patients and resources available for their care.

STUDY OBJECTIVE: To determine the resources available and current practices for the treatment of patients with suicidal ideation or attempts in California emergency departments (EDs). METHODS: We conducted a mail and e-mail survey of the directors of all 346 EDs in the state of California. Data collected included identification of hospital and respondent, type of hospital, presence of separate psychiatric ED, total number of ED patients and number of ED patients with suicidal ideation or attempts who were treated per week, mental health personnel on call to evaluate suicidal patients, criteria for patient disposition, available disposition options, delays in patient care, changes desired in the ED treatment of suicidal patients, and adequacy of community resources for suicidal patients. RESULTS: Two hundred twenty-three of 346 (64.5%) ED directors responded to the survey. Overall, the mean estimate of the proportion of ED visits by suicidal patients was 1.7%. Though evaluation of patients with suicidal ideation by a mental health professional was the usual practice, 51 respondents (23%) reported that they occasionally send patients with suicidal ideation home without such an evaluation, and 8.5% reported this was done more than 10% of the time. No single type of mental health professional, including psychiatrist, social worker, county or private psychiatric evaluation team, psychiatric nurse, or psychologist, was available for evaluation of suicidal patients in more than 50% of respondent EDs. In the majority of EDs, psychiatric evaluations were performed by either mobile county or private psychiatric evaluation teams or social workers on call to the ED. Psychiatrists were reported to evaluate the majority of suicidal patients in only 10% of EDs. Only 27% of respondents had the ability to admit patients to a psychiatric service at their hospital. When patients needed to be transferred, the estimated mean wait for these transfers was 7 hours. Seventy-one percent of respondents reported needing improved access to mental health personnel for evaluation of suicidal patients; 61% reported needing improved access to mental health personnel for patient disposition. CONCLUSION: In California EDs, there are limited mental health services for suicidal patients. Regional solutions to emergency and nonemergency mental health problems are needed, including improved access to mental health personnel for ED evaluation, disposition, and follow-up of suicidal patients and community mental health resources for patient referrals.

Cross-cultural evidence of value structures and priorities in childhood.

We broaden the developmental focus of the theory of universals in basic human values (Schwartz, 1992, Advances in Experimental Social Psychology) by presenting supportive evidence on children's values from six countries: Germany, Italy, Poland, Bulgaria, the United States, and New Zealand. 3,088 7-11-year-old children completed the Picture-Based Value Survey for Children (PBVS-C, Döring et al., 2010, J. Pers. Assess., 92, 439). Grade 5 children also completed the Portrait Values Questionnaire (PVQ, Schwartz, 2003, A proposal for measuring value orientations across nations. Chapter 7 in the Questionnaire Development Package of the European Social Survey). Findings reveal that the broad value structures, sex differences in value priorities and pan-cultural value hierarchies typical of adults have already taken form at this early age. We discuss the conceptual implications of these findings for the new field of children's basic values by embedding them in the recent developmental literature.