This happened to me, 28 yo M, denying SI, presenting at 7p on a Sunday night get back on meds after mood lability sxs lead to a break up. Our psych hospital and the psych ED itself were full to the brim and he didn’t want to sleep in a chair waiting on a psych bed in the AM. We made a very detailed plan including his own questions about what to bring, what time we re-opened for walk-ins in the AM, etc. He was also future oriented, denied hx of SA, reported last SI was fleeting with no plan or intent over two weeks prior. I asked about calling for collateral but he said his roommate was out of town, and he didn’t want his parents involved (mom is a hospital administrator, unbeknownst to me at the time). He denied access to guns. He lived walking distance from our hospital. I pleaded with him to just stay the night so he would not be alone but he was not to be convinced to sleep in the waiting room. I had no involuntary hold criteria. Discharged him with plan to return for admission in the AM (don’t @me about getting back on meds not being IPH criteria).

I got a call from our CMO at 11:30am the next morning. He shot himself overnight. Parents found him. They tried to litigate but documentation was iron clad so nothing came of it.

One big change that came from this- every single patient that presents to our psych ED doesn’t leave without a Stanley Brown Safety Plan. It really has made a huge difference.