Note: I originally planned to write an article entitled “Suicide in Special Populations”, but as I began doing some research, I realized that each population was so filled with research that each would be better split up into individual articles. So this is the first of the series, that I hope will contain suicide in youth, suicide in the elderly, and suicide in the military and police veteran populations.

Hospitalized inpatients are often those suffering from the most severe mental health issues and hospital deaths are among those believed to be most preventable because of the high security and access to psychiatric care, and although the rate of inpatient suicides is low compared to the general population, it is markedly higher than that of non-hospitalized inpatients or those hospitalized for physical health issues.

Research on inpatient suicides is limited, but Sakinofsky (2014) noted a rate by Martin of 1.24 suicides per 1000 suicides in a Canadian psychiatric hospital.

An important consideration to inpatient suicides is that many psychiatric patients can end up in the Emergency Department (ED/ER) where the expertise is in treating physical health issues, rather than mental health ones. (Zeller, 2010)

Legal Considerations

Canadian and American laws are very strict when it comes to involuntary commitment. Even when a patient is hospitalized, physicians may discharge them without a proper assessment, which can open them up to further liability in the event of a suicide.

The exact nature and length of hospitalization depends by province or state. For instance, in Ontario there are four statuses in which you can be admitted, classified based on the number of Form (Form 1, Form 2, Form 3, and Form 4) that the police, a Justice of the Peace or a physician may fill out. (Psychiatric Patient Advocate Office, n.d.)

• Form 1 is a 72-hour psychiatric hold
• Form 2 is a Justice of the Peace form, with which they can use to declare you as likely to be a danger to yourself or others
• Form 3 is a Certificate of Involuntary Admission, filled out by a physician
• Form 4 is a Certificate of Renewal, extending your involuntary admission

Clinical Concerns

According to Sakinofsky (2014) most suicides occurring to inpatients in fact occur when the patient is out of the hospital on a day pass or weekend leave, rather than in the secure hospital environment.

Of course, suicide risk assessment requires careful training and experience and when lives are at stake, there is an important weighing of rights against safety.

Protective and Risk Factors

Protective factors to reduce suicide in inpatients include

• Being placed under appropriate surveillance
• Removing access to suicide methods

Risk factors increasing suicide in inpatients include:

• History of attempted suicide
• Agitation
• Impulsivity
• Being recently admitted or discharged

Bibliography

Psychiatric Patient Advocate Office. “Home – HOME”. Retrieved from “http://www.sse.gov.on.ca/mohltc/ppao/en/Pages/InfoGuides/MentalHealthActAdmissions_D.aspx?openMenu=smenu_MentalHealthActAdm” on February 3, 2015

Sakinofsky, I. (2014) “Preventing suicide among inpatients”. Canadian Journal of Psychiatry. (59)3: 131-40

Statistics Canada. (2014) “Suicides and suicide rate, by sex and by age group (Both sexes no.)” from CANSIM, table 102-0551. Retrieved electronically from http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/hlth66a-eng.htm on January 29, 2015.

Zeller, S. (2010) Treatment of Psychiatric Patients in Emergency Settings. Primary Psychiatry. 17(6):35-41

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