Le suicide dans l'institution

Abstract

More than 50 % of suicides are by patients who have been or are still followed-up. The prevalence of suicidal crises is high (32 %) and stable in populations of chronic psychiatric patients. Suicidal risk factors are well known, nevertheless they are more particularly high during acute crises and are lower when the psychiatric illness is chronic. Five percent of the suicides are committed during hospitalization. Most of them occur on the first month following admission, in the first week of an acute psychotic crisis, within the year after hospitalization, prior to the hospital discharge. The rate of suicide is particularly important in psychiatric institutions because most of their patients are suffering from schizophrenia and/or depression, two diseases with high rates of suicide. Some suicidal risk factors specific to schizophrenia have been identified such as the schizoid-affective form of the disease, patient care that has been delayed, a chronic disease with numerous acute episodes, short and frequent admissions in a hospital, involuntary hospitalisations, extrapyramidal side effects and disruption of treatment. The vulnerability appears to be maximum during the first week and/or the three months after discharge from the hospital, during the first year following the diagnosis and during acute episodes, especially the first one. In the second part of this work, we will examine the legal aspects, based on the main recent court cases relative to hospital liability. The fault usually consists in lack of surveillance and involves the liability of the hospital. The assessment of the adequacy of the measures taken for the medical care of a patient and in particular his/her supervision depends on the predictability of the suicidal act; the severity of the psychiatric illness and more particularly on previous suicidal attempts; previous fugues from the hospital and previous violent acting out especially on the occasion of previous hospitalisations. To avoid reciprocal projections when there is a suicidal act it is essential to work with family and attendants, to obtain clear and exact information about the psychiatric illness and to ensure both medical and administrative care.