Comparison of behaviour and suicide attempt protocols in the world: a scoping review article

ntroduction. Within the annals of philosophy, the question of suicide has persisted as a perennial enigma, transcending epochs of human existence. Framed within the context of the fundamental biopsychosocial model, the comprehension, management, and definition of suicidal behaviors prompt a legitimate inquiry: what are the principal protocols governing the management and intervention strategies for global suicide attempts?

Evidence Acquisition. A Scoping Review, employing the PRISMA-P method and Scoping review search strategy, was conducted over the past five years, utilizing PubMed, Epistemonikos, Lilacs, and Google Scholar databases. MeSH terms (“Suicide behavior” AND “Suicide”) OR (“Mental disorders” AND “therapy”) were employed for the search. Subsequently, emphasis was placed on clinical trial therapy evaluations alongside historical evidence effects. Forty primary studies were identified, with a thorough examination of included articles vis-à-vis the specified inclusion criteria. The analysis encompassed ten primary studies and ten primary historical resources, ensuring a comprehensive overview within this domain.

Conclusion. An integrated mental health system interfaced with the labor infrastructure, duly considering biopsychosocial variables, proffers the advantage of mitigating the incidence of mental and neurological disorders by fostering engagement and activity among the elderly population.

Principal message.  The concept of suicide has been presented a progressive evolution since its sacralization in the preclassical era where it was sin and punishment that dominated the suicidal attempt and act in the times of King Saul, and later the concepts of civic or assisted suicide appeared in times of Socrates and later Mark Antony and Cleopatra who transmuted this concept into a pendulum meaning between logic and creed.

The history of suicide from the philosophy of human thought dates back to sumerian, babylonian, assyrian and hebrews kingdoms times where suicide was considered punishment from the gods, and in classical times the concept of suicide is associated with the sacred of life by the State such as Socrates and Seneca in The Age of Nero. This is where assisted suicide is created. Already in the average age, the concept of suicide is understood as a source of capital sin and the commandments cannot be resurrected or buried, and if they do, they will not be consecrated. It is with Pinel and Esquirol (refers to the image 2 in the romantic period) that suicide is considered a manageable and treatable disease, breaking us down and the patients being treated with different types of treatments, the asylum system was the main one.

Limitations. This scoping review uses both scientific literature sources and gray literature in its preparation, and historical sources derived from universal literature, which adds a subjective component to the appreciation of the authors of their time when describing the epidemiological phenomenon.

Final result. We identified 40 primary studies, we counted the number of studies included in the review that potentially met our inclusion criteria, and noted how many studies had been missed by our search. We analyzed 10 Primary studies and 10 secondary resources, which were included in the scope of this study. It would be advisable to create a Medical Institute Neuromodulation Center Assessment that studies and controls in a coordinated manner, especially in countries with lower per capita income, such as third-world countries where there is a greater risk of the appearance of Mental illness.

INTRODUCTION

“There is but one truly serious philosophical problem: suicide”.

Albert Camus, The Myth of Sisyphus

Approximately 90% of individuals who commit suicide attempt a diagnosable mental disorder, with over 50% linked to major depressive episodes, 25% associated with substance abuse, and around 10% correlated with psychotic disorders such as schizophrenia and bipolar disease. Personality disorders, notably Borderline and Antisocial, are prevalent in about one-third of cases ^1,2.

The principal clinical manifestations of suicide are presented along the all history are suicidal ideation, since the death and suicide of King Saul in the book of kings and the Epic Poem of Gilgamesh to the characterized by thoughts, plans, or desires to end one’s life, precedes suicidal behavior, which encompasses various types of deliberate acts consummated suicide involves the conscious action of causing one’s own demise. Suicide attempts denote deliberate efforts to end one’s life, though without success. Parasuicide, on the other hand, involves consciously inflicting harm, not necessarily with the intent of causing death, often pursued to achieve certain objectives. This category encompasses instrumental or manipulative behaviors that may inadvertently lead to fatal outcomes if intervention is absent ^3,9.

The majority of these suicidal behaviors necessitate urgent medical intervention and are typically managed in general emergency services, where patients are stabilized before receiving psychiatric evaluation. However, direct presentation to psychiatric services occurs at times, potentially delaying prompt attention to somatic consequences, which may be inconspicuous to the untrained observer. Psychiatric assessment in such cases should invariably follow subsequent to medical stabilization ⁴.

Suicidal behavior encompasses a multifaceted process, incorporating self-destructive ideation, a yearning for death, the formulation of lethal plans, and culminating in a suicidal attempt, which, if carried out, results in consummated suicide ⁵. Specifically, a suicidal attempt is construed as an intentional act wherein the individual seeks self-inflicted harm with the aim of terminating their own life. Preceding this, ideation is characterized by the presence of thoughts pertaining to the desire to end one’s life, whether accompanied by planning or not, as reported in Figure 1 and 2 ⁶.

In the post-classical era of the Middle Ages, suicide was morally condemned as a sin, echoing beliefs from earlier times. With the advent of the Baroque period and its rationalist ideologies, suicide became associated with feelings of alienation. Subsequently, during the Romantic era, suicide was reconceptualized as a medical condition necessitating compassionate study and treatment ²⁰.

Several psychiatric comorbidities, notably mood disorders such as major depression, anxiety disorders, substance use disorders, and severe conditions like schizophrenia, have been identified as significant predictors of suicidal behavior ⁷. This understanding enables the identification of demographic groups at heightened risk of suicide compared to the general population, including healthcare professionals and medical students. These individuals often experience heightened stress levels due to factors such as intense academic demands, long working hours, sleep deprivation, challenging work environments, and the weight of responsibility for the well-being of others. Studies conducted by the World Health Organization (WHO) have revealed alarming rates of mental health pathologies among medical students, with reported incidences of depression at 27.2% and suicidal ideation at 11.1%, surpassing the 8% prevalence observed in young people within the general population ⁸.

This classification underscores the imperative of prompt psychiatric emergency response and subsequent management within community psychiatric facilities or asylum systems. which will be detailed below.

METHODS

Evidence acquisition

This literature review aims to illustrate, compare and discuss the mechanisms through which Psychiatric affects social development and health systems in the long term. To achieve this goal, we adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA methodology ^37,38,39. First, we define a list of keywords that express the main aspects of the concepts of “suicide” and “attempt suicide” or “mental disorders” and “protocol” “mental illness” and “institutionalization” or “asylum” and “community psychiatric”. Only articles in languages other than french, english, spanish and italian are excluded. Once the information was obtained, two independent observers, whose names were concealed, carried out a critical analysis of the referenced documents. The original documentary archives of the National Archives of Chile and Italy were consulted, respectively, to obtain primary sources for a more in-depth analysis ^40,41,42.

Matrix of Evidence: http://www.epistemonikos.org/matrixes/64700a217aaac8122d4926ac

We conducted a scoping review of the literature on the management and suicide protocols in the world, following the Preferred Reporting Items for Systematic review and Meta-Analysis extension for Scoping Reviews (PRISMA -ScR) guidelines (Tricco et al, 2018). A pre-search scoping protocol was designed based on the approach suggested by Arksey and O’Malley (Arksey & O’Malley, 2005) and The Joanna Briggs Institute (2015). The PRISMA-ScR checklist and protocol are available in the supplementary materials.

Eligibility criteria

According to what is proposed in the Scoping review methodology by Munn and Tricco, the inclusion criteria of scoping reviews should be based on the mesh terms that can answer the questions under study, and the concept to be examined and the context in which the review takes place. In our review, we applied the following inclusion criteria:

• Primary Clinical trial, Reviews Clinical Guidelines Studies: Three main questions were structured:
  1. What’s the different clinical presentations in suicide behaviour?
  2. What is the difference in management between the urgency and triage in psychiatric hospitals?
  3. What’s the most effective health mental system in attendance of suicide in the sociocultural, anthropological, historical context?

Taking into account the terms of the mesh: focusing on the definitions. In the second question, the terms used were: “Suicide Protocol” AND “Triage” AND”Psychiatric urgency” OR”Ambulance” AND “Ambulatory attendance”, emphasizing how these measures were implemented in the historical context and finally in the third question: “SuicideProtocol”AND AND”Healthcare” OR “Policy” AND “Effectiveness” ; elaborating from the consequences of the texts and the statistical evidence the impacts they had on the control of these diseases.

Secondary studies: Clinical Books, historical writings (books and articles-letters), photographic archives, legal codes of the time and their translations, study articles, and academic programs following the scoping review methodology with the questions raised were considered. among this group.

We kept our review as inclusive as possible; therefore, we include any type of study design, including qualitative analyses, ethnographies, case studies, and observational and analytical studies.

Information sources

Our research included standard databases as well as other sources of information. The standard databases included PubMed, Epistemonikos, Lilacs, Scopus and Scoping Review has been conducted over the past 70 years. We also searched in APSA (Asociación de Psiquiatría Argentina), the National Archives, the Library of the Psychiatric Institute with unpublished books and documents, and Sky. Finally, we established direct contact with local mental health stakeholders, including policymakers, clinicians, and service users via email.

Search strategy

A PubMed, Epistemonikos, Lilacs, and Google scholar Scoping Review was carried out in the last five years, using the PRISMA-P method and the Scoping review search strategy. The MeSH terms “Suicide behaviour” AND “Suicide” OR “Mental disorders” AND “therapy” search. Finally, papers focused on clinical trial therapy evaluation are included and emphasize historical evidence effects. Evidence Synthesis: we identified 40 primary studies, we counted the number of articles included in the review that potentially met our inclusion criteria, and noted how many studies had been missed by our search. We analyzed 10 primary studies and 10 primary historical resources that were included in this study.

Selection process

Two assessors independently reviewed the titles and abstracts and compared them to the inclusion criteria. Disagreements were settled by consensus or by a discussion with a third reviewer if no consensus was reached.

Data extraction and management

The process to extract data was developed from the Implementation Studies Checklist for Reporting Standards and the framework developed by Proctor ⁴⁹. Accordingly, for each included study we extracted general characteristics, such as study type, country, and participants, as well as implementation methods and outcomes, such as acceptability, feasibility, fidelity measures, effectiveness, profitability, and sustainability. A detailed taxonomy is included in the supplemental documents. The data were extracted by one team member and verified by another writer.

BODY OF EVIDENCE

Comparisons between the mental health system to attempt and behaviour suicide

The french Mental Health System management in Behaviour and attempt Suicide

In the French mental health system, it is sectorized and cares for every 45,000 children and adolescents with a highly complex psychiatric center with all medical-psychiatric specialties and a psychiatric hospital for every 70,000 adults and older adults, as reported in Figure 3.

The initial psychiatric assessment commences with emergency psychiatric intervention from the onset of the initial telephone contact. Subsequently, rapid stabilization is achieved, followed by a comprehensive anamnesis and physical examination, including assessment of vital signs. In cases involving poisoning, collaboration between the emergency physician and the emergency psychiatrist ensues, facilitating the determination and dosage calculation of antidotes, alongside the management of toxidromes associated with the autolytic process. The third step entails sedation and immobilization by an expert team ^22,35.

Upon the patient’s awakening and regaining consciousness, a psychiatric examination is conducted as the fourth step. Subsequently, the assessment of suicidal risk is undertaken, distinguishing between short-term and long-term hospitalization based on specific criteria, such as immediate access to a suicide method, presence of a detailed suicide plan, emotional distress, agitation, severe depression, immobilization, and pervasive mental anguish (refer to Figure 3). Clinical agitation and direct access to a suicide method typically indicate a need for prolonged hospitalization with heightened risk, while the presence of one or two of these criteria suggests a shorter hospital stay with the possibility of discharge under medical supervision, typically within a 37-hour timeframe in a designated medical or psychiatric unit ³³.

Following the implementation of psychotherapy, occupational therapy, and cognitive behavioral therapy as deemed appropriate, efforts are made to achieve patient stabilization and consolidation. In cases where medical discharge is deemed appropriate, arrangements are made for transfer to a community hospital with ongoing monitoring or for discharge home with regular follow-up visits conducted by psychiatric nurses and psychotherapists ³⁴.

The argentinian Mental Health System management in Behaviour and attempt Suicide

In Argentina, there is the Italian Hospital for Psychiatric Emergencies, which covers the entire city of Buenos Aires with 25 ambulances that travel throughout the city 24/7, caring for and rescuing all patients with psychiatric emergencies (anxious disorders, first psychotic episode, suicide attempts and suicidal act. Its triage is fueled by the spontaneous demand for security numbers and other emergency services. Care begins from the first moment in the same ambulance where an emergency doctor, an emergency psychiatrist, a nurse and a nursing technician attend and stabilize the patient by simultaneously performing triage, defining before admission to the emergency department whether the patient should receive outpatient treatment, an inpatient stay with a hospitalization in a community-based psychiatric center and a community liaison team, receiving feedback from the external clinics, inter consultations, provincial care centers and court order centers.

Without a doubt, its greatest advantage lies in the effectiveness of detecting severe cases from serious and mild ones immediately and defining the therapeutic conduct, ensuring correct attention when defining the therapy and not delaying the psychiatric evaluation, which constitutes a double advantage, defining a stable hospital load for a megalopolis such as Buenos Aires ¹⁹.

In order to summarize the foundations under which the organization of the emergency health system and mental health ambulances in Argentina is governed; the principles that support the Triage are the following second the Society of Clinical Psychiatry of Argentina

1° That the patient receives the level and quality of attention that the clinical picture requires, and also that the hospital resources are used efficiently.

2° Favor the bioethical principle of clinical justice: clinical efficiency aimed at appropriate attention at the right time.

3° Facilitate the continuity of the evaluation and treatment of the patient, stimulate trust, comfort and information among the patient and their family members.

4° Avoid the generated question blocking access to assistance, promote efficiency in the organization by applying resources in an appropriate time.

5° Providing information, anticipating and planning proposals.

6° Counting on evaluation and control methods, as well as supporting the staff ²⁴.

The Chilean Mental Health System management in Behaviour and attempt Suicide:

Unlike the Argentine mental health system, the Chilean case where psychiatric care is delivered to the only emergency system in the city, which is the Central Emergency care, and to a single Psychiatric Institute, which absorbs the demand from several regions, causes the system to become overwhelmed and collapse, failing to cover the existing demand of patients in these places, leaving a large part of the population without coverage, always being “Kick off” to other family health centers which can do little or nothing unlike the community mental health centers which In some cases they present a therapeutic arsenal of drugs and psychotropic drugs which work with psychotherapists and in some centers with psychiatrists depending on the contribution of the municipal management, generating a liaison psychiatry that allows the tertiary hospital to be partially connected with the primary or secondary care center. to continue the patient’s treatment. Despite having a low resolution in situ and taking over hospital capacity by presenting adequate health devices for its neurodiverse patients, there are particular cases such as the RADAR program whose mission is to prevent and promote healthy behaviors that prevent suicide in child and teenagers ^6,9.

The Psychiatry Program Network for the Care and Referral of Adolescents at Risk named (RADAR Program) in spanish language, represents a commendable initiative with a robust scientific-social framework aimed at preventing suicide among adolescents aged 15 to 17 years. This program is designed to equip primary care providers with the necessary training and tools to effectively identify, refer, and provide care for at-risk individuals, leveraging the involvement of key stakeholders such as family members, educational institutions, and community organizations. Originating as a pilot program in Chile’s Aysén region (XI), the program’s holistic approach fosters a protective social environment that fosters the development of age-appropriate social, psychological, and biological functioning among adolescents. This comprehensive endeavor intersects with the realm of biopolitics, as it addresses the control of mental health factors influencing suicide incidence, prevalence, mortality, and lethality rates ^11,12.

Consequently, it can be inferred that Chile’s healthcare system exhibits a hybrid model characterized by a hospital-centric approach complemented by an emerging community-based component, alongside private clinic services.

Manchester Triage System in emergency care

The Manchester triage model is based on attention times for the on-site resolution of the psychosis episode. This model of care involves the 5 levels of care from the mild level to the very severe level with autolytic attempt and compromise of consciousness and presenting symptoms of a depressive episode or schizophrenia as comorbidities, or having attempted or had a previous suicide attempt with minute attention times in accordance with each level and severity which include mental health criteria such as scenarios for the reason for consultation.

This is very effective and clear at the moment of the attention based on 52 chief complaints associated with medical urgency. Not prest validation, concordance and utility and present specifically to mental health patients ^28,29.

NEW MODEL CENTER IN THE PREVENTION TO ATTEMPT AND BEHAVIOUR SUICIDE IN OLDER MAN

The significance of what it means to be human acquires gigantic limits whose definitions are expressed only through the recognition of rational and reasoned thought structures.

This is the field of work of psychiatry that moves with the philosophical vision of the human

Whose work from the interior of historical time allows to refoundational the true knowledge of what the human being implies being human is not just watch and punishment, being human is living, contemplating and helping to be healthy. The overlap between Philosophy and Psychiatry constitutes a relief that must be minimally arid. Friendship with man and his beneficence are the props that will allow us to establish healthy and lasting relationships. And reconcile with ourselves in a recognition of who we are ¹³.

The proposed model outlines a five-tiered system of attention, each tailored to specific levels of severity and mental health criteria, aligning with 52 chief complaints indicative of medical urgency. This approach ensures efficient and effective care delivery, particularly for mental health patients, by addressing diverse scenarios prompting consultation ¹⁴.

At its core, the model prioritizes prevention of suicide attempts and behaviors among older men. It recognizes the profound significance of human existence, transcending mere observation and punitive measures. Psychiatry, deeply intertwined with philosophical inquiry, endeavors to understand the essence of humanity through rational and reasoned thought processes. This philosophical perspective, rooted in historical context, facilitates a profound exploration of what it truly means to be human ¹⁶.

In essence, being human extends beyond passive observation; it encompasses living, contemplation, and fostering health. The convergence of philosophy and psychiatry offers a fertile ground for exploration, fostering empathy and benevolence in our interactions. Establishing genuine connections and nurturing relationships based on mutual respect and understanding is paramount.

Through this holistic approach, we aim to reconcile with ourselves and embrace our inherent humanity, fostering well-being and resilience in the process.

Below is a refined version of your text, focusing on a proposed model for preventing suicide attempts and behaviors in older men, while emphasizing the philosophical underpinnings of psychiatry.

Principles of the model

1° because they start working life accompanied by a senior. Not alone.

2° because they are guided by experienced people.

3° because the tutor is not tyrant because it is not required by the Brutality of schedules and performance.

4°because in the tutor he sees a possibility of performing the same work in your future.

Hence the educational theories of Lev Vygotsky and proximal development, we can infer from this construct that it is necessary from early childhood to generate a support and surveillance system where any condition that is compatible with a behavior is detected early. and a suicidal act, as shown by the statistical data of the latest post-pandemic studies, the incidence and lethality of the suicide attempt and act have increased exponentially, which is why it is necessary at the level of the life cycle from the schools, churches and from community centers carry out accompaniment as proposed by the German OSPI System ³², optimizing and promoting healthy behaviors, improving environmental mental health sanitation and providing educational and work elements to as the child grows and matures, establishing a dialogue between the therapist and the person so that the patient-person-human being is able to accept the therapy voluntarily and consciously as he or she acquires new tools that improve your resilience with the environment by increasing your neurotic character and increasing your ioistic strengths, overcoming narcissistic ideas and learning from them by integrating yourself into your own experiences without generating personality disorders or psychotic behaviors in your social environment that accepts and loves you. which he is, without undermining his ego, his ello or his superego ³¹.

To achieve this, we have proposed a resilient system of companions and caregivers integrated into the health, educational, labor and cultural system that promote these behaviors through theater, poetry and labor therapy, developing these activities integrated into the national curriculum in order to provide support to ioistic strengths and giving tools to strengthen the resilience and flexibility of the patients’ traits and characters; creating within the company a Corporate Senior Nucleus that will integrate all retired workers who suffer from welfare pensions of 500-900 euros who will accompany children, young people, students, interns and graduates, delivering from their experiential and life knowledge resilience and emotional support tools, supported in turn by monitors, psychotherapists and stockholders ³⁰.

All this added to the public-private support that will provide a contribution of 50% public and 50% private of the gap between 74-80% of the worker’s last contribution and their welfare pension, with the senior worker continuing to pay their contributions and pension payments. It should be noted that these types of activities not only fall into coaching and training but also into learning or integrating into workshops of some art or activity that the pensioner wanted to do at some point in their life; In this way, the young person sees a fruitful and hopeful future where the State and society as a whole welcomes them, not coercively, but friendly, and in turn the elderly accompanies the young person and improves their psychomotor and social skills, reducing the needs of nursing homes. short and long stay for the elderly and integrating the elderly man as a renewed and revitalized man in the society, as detailed in Figure 6 and the analogy between the Figure 7 who represents the burning of the temple of artemis and the proposed preventive model ³⁰.

DISCUSSION

According to the World Health Organization (WHO), approximately 1.5 million people will die from suicide every year by 2020. Attempted suicide is under recorded 43,44, nevertheless, the number of non-fatal episodes is estimated to be 10-40 times higher than that of fatal episodes ⁴⁵. The risk of subsequent suicidal behavior is substantial, between 12% and 25% of those who attempted suicide had another attempt within one year 46, with the first month carrying an especially high risk of repetition ⁴⁷. Furthermore, up to 3% will die by suicide within one year, 9% within 5 years and in studies of longer duration, mortality rates are close to 11% As attempted suicide is the most important predictor of a completed suicide 48, prevention of recurrent suicidal behavior is a high priority.

In the emergency and hospitalary system the time of admission of the patient with suicidal ideation or attempt, health systems have not been able to prevent their reintegration and reattempt, trying to make up for these shortcomings through long-distance interventions such as teleconsultations, remote calls, sending messages and applications on cellular mobile phones fulfilling a function of accompaniment and resolution of instantaneous and preventive long-distance conflicts, identifying risk behaviors and preventing ²⁹. There are other interceptive instances such as Text messaging strategy with software at fixed independent times over a long period of time and without involving a large number of patients. In Chile the program RADAR to showed a good results in the prevention and promotion of health care in relation to attempt and behavior suicide ²⁶.

This interceptive and preventive model should integrate and prevent suicidal attempt and behavior in therapy in young and elderly men and it is a good example of how mental illnesses can be prevented and active follow-up carried out in a mental health program in countries with moderate and moderate-high economic income ²⁷.

Valuing the figure of the senior professional in the training of young replacement generations that have just entered working life, controlling work demands in schedules and in performance evaluation of the senior mediator, while improving the integration and collaboration between older adults and young people, and the understanding of the latter through of the certain possibility of performing the same job in the future, make this intervention a virtuous instrument of integration and development,with political and social responsibility, and its consequent benefits in public health, social security and national identity ²⁴.

CONCLUSION

A mental health system integrated into the labor system that takes biopsychosocial variables into account has the advantage of reducing the rate of mental illnesses and neurological diseases by keeping the elderly busy and active, being a valuable element for society by helping to train to young people who enter the working life, reducing work demands in schedules and performance, improving integration and collaboration between older adults and young people, since the young person sees the possibility of carrying out the same.

Conflicts of interest

The authors have completed the ICJM conflict of interest declaration form and declare that they have not received funding for the preparation of this report; not have done financial relationships with organizations that might have an interest in the published article, in the last three years; and not have other relationships or activities that could influence the published article, in the last three years; and not have other relationships or activities that may influence the published article. The forms can be requested by contacting the responsible author, or the editorial direction of the journal.

Funding

The author declares that they received no funding for this work.

Authors contribution

GGB: formal analysis, writing: original draft, writing: proofreading and editing, visualization.

Protocol Registers

It was not included in this review article in the PROSPERO registry, because our work does not contemplate intervention in humans or animals, but rather a narrative review and analysis of the body of evidence when analyzing primary and secondary sources. from original historical sources.

Greetings and thank you to Gustavo Gómez Ronda for the concept, philosophy and writing of the manuscript, librarian of the institution, and especially to Roger Espinoza and Osvaldo Jil for providing the research resources, who have allowed the development of this research.

Ethical consideration

Ethical aspects This study did not require an ethics committee, as it was an investigation of secondary sources.

Data Access Statement

The authors declare availability for the delivery of databases to those interested.

Data Sharing Statement

Declare willingness to share data.

Figures and tables

FIGURE 1. In the age of sumerian,babylonian, assyrian and hebrews kingdoms times Era of Suicide the concepts to sacred destiny and sins of the man. The innevitable destiny of the gods to the punishment and the sins of the humankind it’s reflexed in the suicide intention and attempt of King Saul because his son Jonathan are deffeated by the forces of King David.

FIGURE 2. This classifications refers to the psychiatry emergency and their posterior management in center psychiatry communitary or Asylum system.

FIGURE 3. Management of suicidal intent and behavior. This a Hospitalary model and communitary model focused on rapid attendance and stabilization ³⁵.

FIGURE 4. Care is focused primarily through triage management at the ambulance level, which is carried by apsychiatrist or an emergency medicine doctor responsible for management with a paramedic. Taken to the APSA publication ²⁴.

FIGURE 5. Comparisons between the mental health system to attempt and behaviour suicide.The mental health systems that have evidenced a complete transition to deinstitutionalization are Australia and Italy; while Chile and Argentina maintain the hybrid system of institutionalized health care, the latter being the one that presents the fastest care regarding triage management inside the ambulance prior to the arrival of the emergency service.

FIGURE 6. The role of Nucleus senior responsibility in the prevention of behavior and attempt suicide promotion the resilience an and mental health patient care.The key event of the break in the continuity of the human being’s life cycle is the loss of a partner or loved one, which causes a wound in the human being’s self with the effects and repercussions such as depression, emotional disorders. anxiety and personality disorders.

FIGURE 7. The institutional psychiatrist, like the community psychiatrist, must play a preventive and integrative role of the psychiatric patient in the social environment, being a risk preventionist or a fireFigureurehter who is responsible for preventing presents suicidal behavior and even a narcissistic wound that causes a split in his personality and between the ego, the id and the superego. Museum di ars decorative, Francia. Wiki Commons 4.0 license.

TABLE I. Research question based on the scoping review methodology.

Question research	Cites	Mesh terms
1. What’s the different clinical presentations in suicide behaviour?	[1-10].	Suicide behaviourSuicidal Attempt;Suicidal ideation;Imitative Behaviour/Literature modern = werther effect Parasuicide
2. What is the difference in management between the urgency and triage in psychiatric hospitals?	[11],[12],[19],[20],[22],[23],[24],[25],[26]	TriagePsychiatric urgencyPsychiatric Urgency hospitalAmbulanceAmbulatory attendanceStabilization
3. What’s the most effective health mental system in attendance of suicide in the sociocultural, anthropological, historical context?	[13],[14],[15],[16],[17,18],[21],[27]	Suicide ProtocolHealthcarePolicyEffectiveness

TABLE II. Comparison of models of psychiatric in treatment of intention and behaviour suicide.

Protocol suicide	Population	Intervention	Outcome	Cite
Defining the Characteristics of an e-Health Tool for Suicide Primary Prevention in the General Population: The StopBlues Case in France	Persons between 13-19 years over 6 weeks to learn emotional resilience, resources of mood.	Applying a ehealth tool for suicide prevention, focus in the suicide behaviour mood	Developing an e-health tool for suicide prevention offers many advantages when adapted to the need of the population. First, its accessibility allows different types of users to access the tool, especially hard-to-reach populations such as underage youth or the socially marginalized	[33]
Validity of the Manchester Triage System in emergency care: A prospective observational study	288,663 patients were included in the analysis.	Application of the triage system in three different centers.	Sensitivity of the MTS in the three hospitals ranged from 0.47 (95%CI 0.44-0.49) to 0.87 (95%CI 0.85-0.90), and specificity from 0.84 (95%CI 0.84-0.84) for the triage of adult patients. In children, sensitivity ranged from 0.65 (95%CI 0.61-0.70) and specificity from 0.83 (95%CI 0.82-0.83).The diagnostic odds ratio ranged from 13.5 (95%CI 12.1-15.0) in adults and from 9.8 (95%CI 6.7-14.5) in children, and was lowest in the youngest patients in 2 out of 3 settings and in the oldest patients in all settings.Validity of the MTS in emergency care is moderate to good, with lowest performance in the young and elderly patients.	[28]
Optimizing Suicide Prevention Programs and their Implementation in Europe (OSPI Europe)	Primary outcome for evaluating the effect of the intervention is the rate of suicidal acts (fatal + non-fatal) in the intervention and the control regions at baseline (six months prior to the start of the intervention), during the 18 months of the intervention and six months after. The main hypothesis is that the number of suicidal acts will decrease in each intervention region compared to baseline	The European Alliance Against Depression (EAAD) intervention consists of (1) training sessions and practice support for primary care physicians, (2) public relations activities and mass media campaigns, (3) training sessions for community facilitators who serve as gatekeepers for depressed and suicidal persons in the community and treatment, and (4) outreach and support for high risk and self-help groups (e.g, helplines). In OSPI, the EAAD model is enhanced by other evidence-based interventions and implemented simultaneously and in a standardized way in four regions	After two years of intervention, a significant reduction in the number of suicidal acts was found compared to the initial year (-24%, p < 0.005). This reduction was clearly significant compared to the corresponding changes in the control region (Wuerzburg). The reduction was even more pronounced (-53%, p < 0.01) in secondary analyzes that examined only the five most lethal suicide attempt methods 13 ]. NAD’s four-level intervention concept was refined and transferred to other EU countries. Thus the European Alliance Against Depression (EAAD) was formed. The EAAD was an EU-funded network of partners from 17 countries that aimed to implement the 4-tier intervention concept in their regions, adapting it to local conditions even while preserving what were considered the key components.	[32]
OSTA program: A French follow up intervention program for suicide prevention	One-year randomized controlled trial with intention to treat n = 325 (160 control) Mean age 29 years. Of a total 579 in emergency services.	Providing an emergency resource card, sending a letter, phone calls and reaching out to the treating doctor following a recent suicide attempt	It did not differ in suicidal reattempt (14.5%)22/152 versus control (14%) 21/150. There were also no differences in suicide attempts.This post-crisis outreach program was accepted by the patients who found it to have a positive preventive impact. Text messaging outreach offers several advantages such as lower cost, and easier utilization compared to current post-acute care strategies.	[34]
Post-acute crisis text messaging outreach for suicide prevention: A pilot study	Patients who have been discharged from the hospital environment who have high grades and retry.15 patients have been enrolled (Figureure. 1). Our study consisted of four men and 14 women from 24 to 61 years old (mean age of 37.8±8.6). psychiatric disorder (11/18, 61%).	Text messaging strategy with software at fixed independent times over a long period of time and without involving a large number of patients.	Subjective effectiveness was explored only to assess the acceptability of the cell phone text messaging outreach intervention. All of the patients, except for one, believed that the text message outreach was a good way to maintain contact with the healthcare team after a suicide attempt. These patients felt that the callback had a positive impact on their health and they found it beneficial overall. More than half stated that the callback had a positive influence on suicidal ideation (8/15, 53.3%) and their psychological health (9/15, 60%). The results were inconsistent among the patients when asked if this system had an impact on suicide recurrence	36.
Effectiveness of distance-based suicide (DBS) interventions: multi-level meta-analysis and systematic review	In total, 11 158 participants were included at post-intervention and 9201 at follow-up. Out of all participants, 64.43% were female and on average 31.87 (s.d. 10.01) years old. The youngest reported mean sample age was 14.70 (s.d. 1.46) years, the oldest mean sample age was 51.00 (s.d. 11.39) years.	Face-to-face psychotherapy interventions (psychoanalytic-cognitive-behavioral) were compared with the rest of the long-distance interventions, via mail, internet, and short-stay hospitalizations.	We found 38 studies, reporting 110 outcomes. Effectiveness in reducing suicidal ideation was low (standardised mean difference -0.174, 95% CI -0.238 to -0.110). DBIs were significantly less effective against suicidal behaviours than against suicidal ideation, although still effective (standardised mean difference-0.059, 95% CI -0.087 to -0.032). Human involvement had no significant effect on effectiveness.	[29]