AAEP Position Statements

The following are established Position Statements put forth by the American Association for Emergency Psychiatry.

AAEP Position Statement: Evaluation of Persons of Concern in Relation to Violence, Mass Shootings and Mental Illness
(April 2018)

In the wake of any highly publicized mass shootings attention seems inevitably drawn to the issue of mental illness.  Public narratives on this issue are often incorrect, misleading and stigmatizing.  Evidence clearly indicates that at least 90% of violence is not driven by mental illness and that the vast majority of people living with mental illness are not violent.  Mass shootings are a rare subtype of violence; studies of mass shootings use inconsistent and at times nonspecific definitions of mental illness as well as of what constitutes a mass shooting itself.  Likely, as few as 15-25% of perpetrators of such attacks have a prior psychiatric diagnosis, which itself says nothing as to a causal relationship.

Inarguably, there is an intersection between violence and mental illness: there is a small subset of people with mental illness who, often at the peak intensity of their illness and in the presence of numerous other risk factors, are violent.  There is also evidence that some people who plan or engage in mass shootings are driven towards such acts at least in part by their psychiatric illness.   Psychiatric emergency services routinely evaluate people with or without psychiatric illnesses who are at potential risk of violence.  In the wake of any highly publicized threat or attack of this nature, threats and referrals for evaluations of threats go up often impacting referrals to psychiatric and emergency services.

The American Association for Emergency Psychiatry exists to champion the advancement of evidence based, compassionate care for behavioral emergencies through research, education and interdisciplinary collaboration.  As such, it is our position, based upon available evidence and best practices that:

  • All threats of violence must be taken seriously and receive a psychiatric evaluation within the capacity of the facility
  • Optimal use of emergency and general psychiatric services will not eliminate community violence or mass shootings because of the limited role psychiatric illness plays in such events; however, when such cases do arise and are clinically identified, every reasonable clinical intervention should be considered
  • Recognizing that violence is often multifactorial, consultation and collaboration amongst professionals (including healthcare and law enforcement) should be used to support multidisciplinary assessment and intervention including accessible psychiatric treatment
  • Emergency Department and PES decision making should reflect clinically appropriate, ethical and legal practices
  • Care of violent and threatening patients is challenging and PES and ED programs should provide staff wellness resources to support optimal team performance
  • The science of violence and firearm injury prevention is an actively developing science.  Clinicians should consider violence an essential element of continuing education and the AAEP will prioritize relevant education and training for the membership
  • Understanding concerns about media-related contagion, communications by healthcare providers or hospital spokespersons relating to such events should adhere when possible to best practices (www.reportingonmassshootings.org) including avoiding glamorizing the assailant or attack, using behavioral health experts to explain the science, and explaining that violence and mass shootings are complex with multiple causes.

 

AAEP Position Statement: Suicide Screening
(September 2017)
The American Association for Emergency Psychiatry promotes timely, compassionate, and effective mental health services for persons with mental illnesses, regardless of their ability to pay, in all crisis and emergency care settings.  Based on our mission, AAEP supports universal suicide screening of patients in the emergency setting and appropriate funding for screening and indicated services.