Conference Agenda

Introduction: Research indicates that autistic people visit emergency departments (EDs) more often than those without autism, and experience higher rates of suicidal thoughts and behaviours. It is therefore important to understand how often autistic people visit EDs, for what reasons, and how best to offer support. This systematic review aimed to look at all the available literature focussing on ED attendance in autistic populations with a specific focus on suicidal thoughts and behaviours and self-harm.

Methods: Five electronic databases (MedLine, CINAHL, PsycINFO, Web of Science and Cochrane Library databases) were searched for three key concepts: (1) suicide, self-harm and suicidality (2) accident and emergency department and (3) autism. Three reviewers screened titles, abstracts and full papers independently against the eligibility criteria. Data synthesis was achieved by extracting and analysing study characteristics and findings. Included studies were quality assessed using the Quality Assessment Tool for Quantitative Studies (EPHPP).

Results: Twenty-four studies met the eligibility criteria. Studies were published from 2017 to 2025 and were of moderate methodological quality. The majority of studies (n=19) utilized a case series design analysing retrospective data from one hospital during a defined time period.

Discussion: The review highlighted increased use of EDs (e.g., multiple, repeat visits) in both adult and paediatric autistic populations when compared to the general population. Papers looking at autistic children and young people (aged under 30) made up a majority of the papers (n=17) and highlighted elevated ED attendance for suicidal thoughts and behaviours and self-harm. There are a number of implications for clinical practice including the importance of early identification and intervention with autistic individuals who may be at an increased risk for suicidal crisis. EDs are a crucial source of mental health care and provide a vital opportunity for suicide screening and signposting to relevant services.

Introduction: Suicide is a leading cause of death among children and young people (CYP) worldwide. However, while evidence exists regarding factors associated with suicide and self-harm, there is limited information available on the CYP who present in suicidal crisis, despite it being a well-established risk factor for death by suicide.

Aim: This study aimed to examine Emergency Department (ED) attendances for CYP in suicidal crisis, including demographic data, methods of recording patient attendance, the clinical pathways available and patterns of pathway usage, and differences in presentations before and after the COVID-19 pandemic.

Methods: This is a case series study of CYP experiencing suicidal crisis who presented at an ED at an English paediatric hospital between March 2019 and March 2021 (n=240). Clinical records were extracted and audited, and descriptive and inferential (t-tests, chi-square, regressions) statistical tests were conducted.

Results: Attendees were mostly white females (mean age 13.5 years), 24% had a diagnosed special educational need, most commonly autism, and a further 21% were suspected of having autistic traits. “Social/social problems” was the most commonly used code for recording attendance (38%), and care pathways were influenced by code use. A range of parental and familial factors were also identified as significant predictors. There were significantly more CYP presenting with self-harm in addition to suicide ideation after the pandemic began (43 vs 27% pre-pandemic).

Conclusion: This study provides the first clear insight into CYP in England who are experiencing suicidal crisis. Inconsistent codes are used to record hospital admissions for suicidal crisis in CYP, and this influences the clinical pathways CYP follow. Females, particularly those who are autistic and those whose parents are experiencing difficulties, are more likely to present in suicidal crisis. Work is now needed to develop effective prevention strategies tailored towards these groups.

Background: Accurate identification of suicidal crisis presentation to emergency departments (EDs) can lead to timely mental health support, improve patient experience, and support evaluations of suicide prevention initiatives. Poor coding practices within EDs are preventing appropriate patient care. Aims of the study are to (1) examine current suicide-related coding practices, (2) identify the factors that contribute to staff decision-making and patients receiving the incorrect code or no code.

Method: A mixed-methods study was conduced. Quantitative data were collated from six EDs across Merseyside and Cheshire, United Kingdom from 2019 to 2021. Attendances were analysed if they had a presenting complaint, chief complaint, or primary diagnosis code related to suicidal crisis, suicidal ideation, self-harm or suicide attempt. Semi-structured interviews were conducted with staff holding various ED positions (n=23).

Results: A total of 15,411 suicidal crisis and self-harm presentations were analysed. Of these, 21.8% were coded as ‘depressive disorder’ and 3.8% as ‘anxiety disorder’. Absence of an appropriate suicidal crisis code resulted in staff coding presentations as ‘no abnormality detected’ (23.6%) or leaving the code blank (18.4%). The use of other physical injury codes such as ‘wound forearm’, ‘head injury’ were common. Qualitative analyses elucidated potential causes of inappropriate coding, such as resource constraints and problems with the recording process.

Conclusion: People attending EDs in suicidal crisis were not given a code that represented the chief presentation. Improved ED coding practices related to suicidal crisis could result in considerable benefits for patients and more effective targeting of resources and interventions.

Background: Self-harm is a national and global public health priority. There is an urgent need to provide timely treatment for those who self-harm as it is the most important risk factor for suicide. This study aims to examine the effects of a nurse-led, hospital outpatient psychotherapy engagement (HOPE) service for self-harm on emergency hospital admissions.

Method: A longitudinal synthetic control study to compare the change in outcomes in the intervention population to a similar synthetic comparison group, five years before and three years after implementation. A hospital based, outpatient service providing psychotherapy for people who attended a North-West hospital in England for self-harm from 2017–2020. Emergency hospital attendances (accident and emergency attendance), emergency hospital admissions and emergency re-admissions for self-harm.

Results: The intervention was associated with 64% (95% CI: 43%-77%, p<0.001) fewer in self-harm related emergency attendances per 100,000 population in the treated area compared to the synthetic control group. No marked effects were observed for the admissions and reattendances outcomes.

Conclusions: We found some evidence that suggests there were fewer self-harm related emergency for treated areas. However, these results look to be due to an increase in the control areas rather than a reduction in the treated area and were not seen across other outcomes. The attendance rate increased in both groups in the post-implementation period, however the increase was much higher in the synthetic control group. The results of the additional sensitivity analysis indicate that the results should be interpreted with caution.