Most suicides among psychiatric in-patients occur while they are away from the hospital, either with or without permission, a study has found. There is also a higher risk of suicide in the first week of admission to a psychiatric unit.
The study, by Dr Eleanor Corcoran, of St Conal's Hospital, Letterkenny, and Dr Dermot Walsh, Inspector of Mental Hospitals, is reported in the Irish Journal of Psychological Medicine.
It found that 146 psychiatric in-patients died by suicide from 1983 to 1992. Only 36 of these died in a psychiatric unit. Some 58 were on authorised leave from the hospital when they died and another 52 had left without permission.
"Suicide was particularly common shortly after admission," the authors say. "Six suicides occurred on the day of admission and 25 (17 per cent) in the first week". Of all in-patient suicides, 48 (32 per cent) occurred within one month of admission.
Short-stay psychiatric patients are a particularly high-risk group, with a suicide rate almost 40 times higher than normal.
Those who died had an average 10-year history of mental illness and had been in hospital several times. Nearly half (47 per cent) suffered from depression and more than a third (39 per cent) had schizophrenia.
Some suicides occurred "while individual patients' consultants were on leave, leading to discontinuity of care, sometimes with inadequate covering arrangements," they write.
The authors urge psychiatric staff to ensure the social stresses patients face are resolved before discharging them or sending them on leave. They also urge hospitals to reduce the number of exits from acute wards.
Other studies have found that social isolation in a psychiatric hospital increases the risk of suicide. For this reason the authors recommend that "supportive family and friends should be involved from the outset in the treatment process and encouraged to visit freely when appropriate".
Hospital staff need to improve their assessment of suicide risk before discharging patients or giving them leave, they say.
Psychiatric services should be provided in such a way that young adults - a high-risk group - are encouraged to persevere with treatment.
email: pomorain@irish-times.ie