{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T12:55:04Z","timestamp":1793364904963,"version":"4.5.0"},"reference-count":61,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T00:00:00Z","timestamp":1711324800000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,1,17]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify and describe evidence on brief emergency department (ED)-delivered behavioural and care process interventions among patients presenting with suicide attempt or acute ideation, substance overdose or psychosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We employed a scoping review design and searched multiple data sources, clinical trial registries and references lists through March 2023. We included English-language trials and rigorously designed observational studies. In alignment with scoping review guidelines, we did not assess the quality of included studies or rate the strength of evidence of intervention effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>Our population of interest was adults presenting to the ED with suicidality (eg, attempt or acute ideation), any substance overdose or acute psychosis from a primary mental health condition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>We included studies of brief behavioural or care process interventions delivered in the ED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Health outcomes (eg, symptom reduction), healthcare utilisation and harms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our search identified 2034 potentially relevant articles. We included 40 studies: 3 systematic reviews and 39 primary studies. Most studies (n=34) examined ED interventions in patients with suicide attempt or suicidal ideation, while eight studies examined interventions in patients with opioid overdose. No studies examined ED interventions in patients with acute psychosis. Most suicide prevention studies reported that brief psychological, psychosocial or screening and triage interventions reduce suicide and suicide attempt following an ED visit. Most clinical trial interventions were multicomponent and included at least one follow-up. All substance overdose studies focused on opioids. These studies often contained medication and referral or consultation components. Multiple studies reported increases in substance use disorder treatment utilisation; evidence on repeat overdose events was limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A wide range of multicomponent ED-delivered behavioural health interventions for suicidality and opioid use disorder show short-term improvement on primary outcomes such as suicide reattempt. Few studies on non-opioid substances and psychosis are available.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-080023","type":"journal-article","created":{"date-parts":[[2024,3,26]],"date-time":"2024-03-26T00:16:02Z","timestamp":1711412162000},"page":"e080023","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Behavioural mental health interventions delivered in the emergency department for suicide, overdose and psychosis: a scoping review"],"prefix":"10.1136","volume":"14","author":[{"given":"Shannon M","family":"Nugent","sequence":"first","affiliation":[{"name":"Center to Improve Veteran Involvement in Care, Portland VA Medical Center, Portland, Oregon, USA"},{"name":"Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Anderson","sequence":"additional","affiliation":[{"name":"Evidence Synthesis Program, Portland VA Medical Center, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0224-7176","authenticated-orcid":false,"given":"Sarah K","family":"Young","sequence":"additional","affiliation":[{"name":"Evidence Synthesis Program, Portland VA Medical Center, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,3,25]]},"reference":[{"key":"2025121603413755000_14.3.e080023.1","unstructured":"SAMHSA . Highlights for the 2020 national survey on drug use and health. 2020. Available: https:\/\/www.samhsa.gov\/data\/sites\/default\/files\/2021-10\/2020_NSDUH_Highlights.pdf"},{"key":"2025121603413755000_14.3.e080023.2","doi-asserted-by":"crossref","unstructured":"Cairns C , Kang K . National hospital ambulatory medical care survey: 2020 emergency department summary tables 2020. n.d. Available: https:\/\/dx.doi.org\/10.15620\/cdc:121911","DOI":"10.15620\/cdc:121911"},{"key":"2025121603413755000_14.3.e080023.3","unstructured":"Cairns C , Kang K . National hospital ambulatory medical care survey: 2018 emergency department summary tables. 2020. Available: https:\/\/www.cdc.gov\/nchs\/data\/nhamcs\/ web_tables\/2018_ed_web_tables-508.pdf"},{"key":"2025121603413755000_14.3.e080023.4","unstructured":"Drug Abuse Warning Network (DAWN) . Non-fatal overdoses short report: substance abuse and mental health services administration. 2023. Available: https:\/\/www.samhsa.gov\/data\/report\/dawn-non-fatal-overdoses"},{"key":"2025121603413755000_14.3.e080023.5","first-page":"1","article-title":"Emergency department visits with suicidal Ideation: United States, 2016- 2020","volume":"2023","author":"Strashny","year":"2023","journal-title":"NCHS Data Brief"},{"key":"2025121603413755000_14.3.e080023.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0195687","article-title":"Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses","volume":"13","author":"Moreno-K\u00fcstner","year":"2018","journal-title":"PLoS One"},{"key":"2025121603413755000_14.3.e080023.7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.501"},{"key":"2025121603413755000_14.3.e080023.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1811988"},{"key":"2025121603413755000_14.3.e080023.9","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.annemergmed.2012.02.003","article-title":"Alcohol and drug use disorders among adults in emergency department settings in the United States","volume":"60","author":"Wu","year":"2012","journal-title":"Ann Emerg Med"},{"key":"2025121603413755000_14.3.e080023.10","unstructured":"Department of Veterans Affairs . Department of veterans affairs FY 2018-2024 strategic plan (refreshed May 31, 2019). 2019."},{"key":"2025121603413755000_14.3.e080023.11","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1001\/jamainternmed.2017.0147","article-title":"Addressing the opioid epidemic in the United States: lessons from the Department of Veterans Affairs","volume":"177","author":"Gellad","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2025121603413755000_14.3.e080023.12","unstructured":"Nugent S , Anderson J , Young S . Evidence compendium: effectiveness of mental health interventions in the emergency department. Report no.: VA ESP project #09-199. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs, 2021."},{"key":"2025121603413755000_14.3.e080023.13","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.jad.2014.12.048","article-title":"Interventions to prevent repeat suicidal behavior in patients admitted to an emergency department for a suicide attempt: a meta-analysis","volume":"175","author":"Inagaki","year":"2015","journal-title":"J Affect Disord"},{"key":"2025121603413755000_14.3.e080023.14","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-018-1663-5","article-title":"Effectiveness of brief psychological interventions for suicidal presentations: a systematic review","volume":"18","author":"McCabe","year":"2018","journal-title":"BMC Psychiatry"},{"key":"2025121603413755000_14.3.e080023.15","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.annemergmed.2017.01.036","article-title":"Clinical policy: critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department","volume":"69","author":"Nazarian","year":"2017","journal-title":"Ann Emerg Med"},{"key":"2025121603413755000_14.3.e080023.16","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291705005416"},{"key":"2025121603413755000_14.3.e080023.17","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1521\/pedi_2015_29_196","article-title":"Disappointed love and suicide: a randomized controlled trial of \"abandonment psychotherapy\" among borderline patients","volume":"30","author":"Andreoli","year":"2016","journal-title":"J Pers Disord"},{"key":"2025121603413755000_14.3.e080023.18","doi-asserted-by":"crossref","DOI":"10.2196\/16253","article-title":"An interactive web-based lethal means safety decision aid for suicidal adults (lock to live): pilot randomized controlled trial","volume":"22","author":"Betz","year":"2020","journal-title":"J Med Internet Res"},{"key":"2025121603413755000_14.3.e080023.19","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.5.563"},{"key":"2025121603413755000_14.3.e080023.20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2009.00619.x"},{"key":"2025121603413755000_14.3.e080023.21","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.07.046995"},{"key":"2025121603413755000_14.3.e080023.22","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-015-0635-2","article-title":"Structured follow-up by general practitioners after deliberate self-poisoning: a randomised controlled trial","volume":"15","author":"Grimholt","year":"2015","journal-title":"BMC Psychiatry"},{"key":"2025121603413755000_14.3.e080023.23","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001968","article-title":"A novel brief therapy for patients who attempt suicide: a 24-months follow-up randomized controlled study of the attempted suicide short intervention program (ASSIP)","volume":"13","author":"Gysin-Maillart","year":"2016","journal-title":"PLOS Med"},{"key":"2025121603413755000_14.3.e080023.24","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1111\/sltb.12626","article-title":"Brief cognitive-based psychosocial intervention and case management for suicide attempters discharged from the emergency department in Taipei, Taiwan: a randomized controlled study","volume":"50","author":"Lin","year":"2020","journal-title":"Suicide Life Threat Behav"},{"key":"2025121603413755000_14.3.e080023.25","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.332.7552.1241"},{"key":"2025121603413755000_14.3.e080023.26","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1176\/appi.ps.202100561","article-title":"Feasibility of peer-delivered suicide safety planning in the emergency department: results from a pilot trial","volume":"73","author":"Wilson","year":"2022","journal-title":"PS"},{"key":"2025121603413755000_14.3.e080023.27","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2019-212623"},{"key":"2025121603413755000_14.3.e080023.28","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1001\/jamapsychiatry.2017.0678","article-title":"Suicide prevention in an emergency department population: the ED-SAFE study","volume":"74","author":"Miller","year":"2017","journal-title":"JAMA Psychiatry"},{"key":"2025121603413755000_14.3.e080023.29","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1001\/jamapsychiatry.2018.1776","article-title":"Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency Department","volume":"75","author":"Stanley","year":"2018","journal-title":"JAMA Psychiatry"},{"key":"2025121603413755000_14.3.e080023.30","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1016\/j.ajem.2020.05.030","article-title":"Effect of previous emergency psychiatric consultation on suicide re-attempts - a multi-center observational study","volume":"38","author":"Son","year":"2020","journal-title":"Am J Emerg Med"},{"key":"2025121603413755000_14.3.e080023.31","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1089\/tmj.2018.0227","article-title":"Telehealth decreases rural emergency department wait times for behavioral health patients in a group of critical access hospitals","volume":"25","author":"Fairchild","year":"2019","journal-title":"Telemed J E Health"},{"key":"2025121603413755000_14.3.e080023.32","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3999(00)00225-7"},{"key":"2025121603413755000_14.3.e080023.33","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.genhosppsych.2019.01.002","article-title":"Virtual monitoring of suicide risk in the general hospital and emergency department","volume":"63","author":"Kroll","year":"2020","journal-title":"Gen Hosp Psychiatry"},{"key":"2025121603413755000_14.3.e080023.34","first-page":"725","article-title":"Implementing an emergency department telephone follow-up program for suicidal patients: successes and challenges","volume":"45","author":"Catanach","year":"2019","journal-title":"Jt Comm J Qual Patient Saf"},{"key":"2025121603413755000_14.3.e080023.35","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1027\/0227-5910\/a000331","article-title":"Telephone management program for patients discharged from an emergency department after a suicide attempt: a 5-year follow-up study in a Spanish population","volume":"36","author":"Cebria","year":"2015","journal-title":"Crisis"},{"key":"2025121603413755000_14.3.e080023.36","doi-asserted-by":"publisher","DOI":"10.1080\/10398560601083068"},{"key":"2025121603413755000_14.3.e080023.37","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2021.746805","article-title":"Adapting caring contacts for veterans in a department of veterans affairs emergency department: results from a type 2 hybrid effectiveness-implementation pilot study","volume":"12","author":"Landes","year":"2021","journal-title":"Front Psychiatry"},{"key":"2025121603413755000_14.3.e080023.38","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1027\/0227-5910\/a000803","article-title":"A shelter in the storm - acceptability and feasibility of a brief clinical intervention for suicidal crisis","volume":"43","author":"Mansfield","year":"2022","journal-title":"Crisis"},{"key":"2025121603413755000_14.3.e080023.39","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1007\/s10597-020-00575-x","article-title":"Counseling on access to lethal means in the emergency Department: A script for improved comfort","volume":"56","author":"Mueller","year":"2020","journal-title":"Community Ment Health J"},{"key":"2025121603413755000_14.3.e080023.40","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1016\/j.ajem.2018.12.034","article-title":"The effects of case management program completion on suicide risk among suicide attempters: a 5-year observational study","volume":"37","author":"Shin","year":"2019","journal-title":"Am J Emerg Med"},{"key":"2025121603413755000_14.3.e080023.41","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-017-1258-6","article-title":"Effect of telephone follow-up on repeated suicide attempt in patients discharged from an emergency psychiatry Department: a controlled study","volume":"17","author":"Exbrayat","year":"2017","journal-title":"BMC Psychiatry"},{"key":"2025121603413755000_14.3.e080023.42","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1080\/01612840.2019.1692979","article-title":"Impact of the mental health care continuity-chain among individuals expressing suicidal behaviour in a Spanish sample","volume":"41","author":"Albuixech-Garc\u00eda","year":"2020","journal-title":"Issues Ment Health Nurs"},{"key":"2025121603413755000_14.3.e080023.43","doi-asserted-by":"crossref","first-page":"1570","DOI":"10.2105\/AJPH.2015.302656","article-title":"Brief intervention and follow-up for suicidal patients with repeat emergency department visits enhances treatment engagement","volume":"105","author":"Stanley","year":"2015","journal-title":"Am J Public Health"},{"key":"2025121603413755000_14.3.e080023.44","doi-asserted-by":"crossref","first-page":"S33","DOI":"10.2105\/AJPH.2011.300501","article-title":"An emergency Department-based brief intervention for veterans at risk for suicide (SAFE VET)","volume":"102 Suppl 1","author":"Knox","year":"2012","journal-title":"Am J Public Health"},{"key":"2025121603413755000_14.3.e080023.45","doi-asserted-by":"publisher","DOI":"10.1136\/injuryprev-2017-042676"},{"key":"2025121603413755000_14.3.e080023.46","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2022.25582","article-title":"Effect of a peer-led behavioral intervention for emergency department patients at high risk of fatal opioid overdose: a randomized clinical trial","volume":"5","author":"Beaudoin","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2025121603413755000_14.3.e080023.47","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.addbeh.2018.09.027","article-title":"Implementing peer recovery services for overdose prevention in Rhode Island: an examination of two outreach-based approaches","volume":"89","author":"Waye","year":"2019","journal-title":"Addict Behav"},{"key":"2025121603413755000_14.3.e080023.48","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1080\/00952990.2020.1841218","article-title":"Implementing hospital-based peer recovery support services for substance use disorder","volume":"47","author":"Liebling","year":"2021","journal-title":"Am J Drug Alcohol Abuse"},{"key":"2025121603413755000_14.3.e080023.49","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1016\/j.ajem.2020.03.005","article-title":"One million screened: scaling up SBIRT and buprenorphine treatment in hospital emergency departments across Maryland","volume":"38","author":"Monico","year":"2020","journal-title":"Am J Emerg Med"},{"key":"2025121603413755000_14.3.e080023.50","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.annemergmed.2018.01.054","article-title":"Safety of a brief emergency Department observation protocol for patients with presumed fentanyl overdose","volume":"72","author":"Scheuermeyer","year":"2018","journal-title":"Ann Emerg Med"},{"key":"2025121603413755000_14.3.e080023.51","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1111\/acem.13545","article-title":"Adoption and utilization of an emergency department naloxone distribution and peer recovery coach consultation program","volume":"26","author":"Samuels","year":"2019","journal-title":"Acad Emerg Med"},{"key":"2025121603413755000_14.3.e080023.52","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.annemergmed.2021.02.004","article-title":"Rhode Island\u2019s opioid overdose hospital standards and emergency department naloxone distribution, behavioral counseling, and referral to treatment","volume":"78","author":"Samuels","year":"2021","journal-title":"Ann Emerg Med"},{"key":"2025121603413755000_14.3.e080023.53","first-page":"6","article-title":"Case series of patients with opioid use disorder and suicidal Ideation treated with buprenorphine","volume":"5","author":"Spaderna","year":"2021","journal-title":"Clin Pract Cases Emerg Med"},{"key":"2025121603413755000_14.3.e080023.54","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1080\/13811118.2016.1199987","article-title":"Suicide risk assessment and management: real-world experience and perceptions of emergency medicine physicians","volume":"21","author":"Roy","year":"2017","journal-title":"Arch Suicide Res"},{"key":"2025121603413755000_14.3.e080023.55","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.genhosppsych.2015.06.018","article-title":"Barriers and Facilitators of suicide risk assessment in emergency departments: a qualitative study of provider perspectives","volume":"37","author":"Petrik","year":"2015","journal-title":"Gen Hosp Psychiatry"},{"key":"2025121603413755000_14.3.e080023.56","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1027\/0227-5910\/a000445","article-title":"Psychiatric consultation and referral of persons who have attempted suicide","volume":"38","author":"Roelands","year":"2017","journal-title":"Crisis"},{"key":"2025121603413755000_14.3.e080023.57","doi-asserted-by":"crossref","first-page":"471","DOI":"10.5811\/westjem.2021.8.49485","article-title":"Lethal means counseling for suicidal adults in the emergency department: a qualitative study","volume":"22","author":"Siry","year":"2021","journal-title":"West J Emerg Med"},{"key":"2025121603413755000_14.3.e080023.58","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2006.06.026"},{"key":"2025121603413755000_14.3.e080023.59","article-title":"Evidence-based approach to psychosis in the emergency department","volume":"40","author":"Kennedy","year":"2019","journal-title":"Emerg Med Rep"},{"key":"2025121603413755000_14.3.e080023.60","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2015.15050632"},{"key":"2025121603413755000_14.3.e080023.61","unstructured":"Priebe S , Golden E , Kingdon D , et al . Programme grants for applied research. NIHR Journals Library, 2017: 02."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-080023","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T11:41:51Z","timestamp":1765885311000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-080023"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3]]},"references-count":61,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3,25]]},"published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1136\/bmjopen-2023-080023"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-080023","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3]]}}}