The second example, a 55-year-old man who has just lost his job. His wife arrives home to find him shaking, saying over and over again, “My head is going to explode. I don’t know what to do.” His wife sees him making phone calls, in a frantic manner, though no one picks up. Frightened by her husband’s agonized state, she takes him to the hospital, where he refuses to explain why he lost his job, something he’s also refused to discuss with his wife. In the emergency room, he asks to be discharged, arguing that he is not suicidal, never has been, and that he wants to go home and start looking for a new job.

Despite his vehement denials about suicidality, this patient should not be sent home, according to Galynker. He is visibly agitated, showing affective disturbance and arousal. All the phone calls he made suggest he is desperately trying to solve the problem of being fired. His repeated muttering about his head exploding suggests a loss of cognitive control, specifically ruminative flooding. His refusal to tell his wife or the doctor why he lost his job are evasions that indicate feelings of social isolation.

The team that Galynker leads has applied to have SCS included as a diagnosis in the preeminent mental health manual, DSM-5. That application should be greenlighted, said Barnhorst. Others have expressed skepticism, such as Dr. Paul S. Appelbaum, a professor of psychiatry at Columbia University. He recently told The New York Times that an SCS diagnosis could have a “stigmatizing effect,”  affecting a patient’s “insurability.” But Barnhorst said, “I am not a big proponent of not doing things because they might be stigmatizing.”

Corey N. Goldstein, an assistant professor at Rush University Medical Center in Chicago who is board certified in both emergency medicine and psychiatry, acknowledged that insurability is a complex question. “Now [by law] you can’t discriminate against people based on their medical history,” he pointed out. “But that could change at any moment.” An SCS diagnosis could also affect a person’s ability to get life insurance or disability insurance. Dr. Goldstein he acknowledged that stigmatization is not insignificant, adding, “If that is the case, does [an SCS diagnosis] increase safety and save lives? Because if it does that on a significant level, then it might be worth the potential downsides.”

Goldstein said he thinks there’s value in using an SCS tool. “Most emergency physicians have [an] obvious background in evaluating mental health symptoms and risk, but we all would like to improve care and our ability to really figure out who needs help, who needs to stay, and who can be discharged, because psychiatrists are not always available in hospital settings. On top of that, there are a limited number of psychiatric beds available.” SCS can help doctors make effective, efficient choices, he said.