Improved Screening of Suicidal Patients in the Emergency Room on Maui

Psychiatric patients who present as suicidal in the main rural emergency room on Maui are not being evaluated with a standard and reliable screening tool. This creates unreliable admission criteria and inconsistent outcomes for patients. Several patients who would have benefitted from admission were discharged which have led to adverse events in the community. These patients were put at risk of adverse outcomes such as physical injury, self harm, non-compliance with medications, and repeat visits to the emergency room. A gap also exists in treating the chronically mentally ill. These patients experience further cortical degradation and an inability to care for themselves (Selvaraj, 2018). The statutes of Hawaii do not allow for involuntary holds of the mentally ill. Criteria for involuntary holds includes those patients who are either suicidal or homicidal. Without involuntary holds, the severely mentally ill can be discharged without clear follow-up, endangering their well-being. The purpose of this project was firstly, to implement improved screening methods for suicidal patients in the ER and to highlight the need for policy change regarding admission criteria for mentally ill patients in the ER, and secondly, to indicate the need for change of policy regarding the Hawaii Revised Statute 334.59 in terms of involuntary admission of the mentally ill.