Emergency Department Telehealth for Improving Outcomes Related to Suicide (ETHOS)

About This Grant

PROJECT SUMMARY/ABSTRACT Children and adults in the US are increasingly seeking treatment in Emergency Departments (EDs) for suicide ideation (SI) and suicide attempt (SA), and suicide is a leading cause of death across age groups. The ED setting has become a critical point of intervention to prevent suicide in the US. In spite of this demonstrated need, most EDs lack resources to address suicide risk, and there is an urgent need to identify strategies to improve evidence-based care for the high-risk and vulnerable individuals who seek ED care due to suicidal ideation or suicide attempt. There is increasing interest in the use of technology to address provider shortages and related gaps in care. Tele-mental health, hereafter “telehealth,” relies on technologies including video- and audio-conferencing with remote clinicians and use of shared electronic health records to improve access to remote mental health specialists. To date, little is known about how EDs use telehealth, and specifically how telehealth services integrate suicide prevention practices for patients at high risk of suicide. The objectives of this project are to gain a comprehensive picture of whether telehealth increases access to treatment and improves treatment outcomes, to understand which patients benefit most from telehealth and which elements of telehealth are most beneficial, and to gather information relevant to understanding the mechanisms by which telehealth influences outcomes. The study team will link data from a previous NIMH-supported survey about EDs’ use of telehealth with health care claims from national samples of individuals insured by Medicaid and Optum private payers to examine relationships between patient receipt of care via telehealth and patient outcomes of post-ED visit connection to follow-up mental health care within 30 days and ED or hospital revisit within 90 days. The team will conduct semi-structured interviews with a subset of ED leaders, clinicians, and mental health consumer advocates around the country to understand facilitators and barriers to telehealth implementation within EDs and mechanisms by which telehealth influences patient outcomes.