Prevention of Inpatient Suicides: An Attempt to Portray an Approach

Abstract

Inpatient Suicide (IPS) is the second most common sentinel event reported to the Joint Commission. Psychiatric inpatient suicide rates in the USA, China, New Zealand, Australia, and the UK range from 0.1% to 0.4% for all psychiatric admissions. Population-based mortality studies in psychiatric care show a 16-fold risk for suicide among psychiatric inpatients and a 2-3-fold greater risk for outpatients compared to the risk for outpatients treated in primary care. The risk factors for suicides in inpatient setting and general population differ. Moreover, the identified risk factors for IPS have relatively low degree of association. Nevertheless, psychiatric inpatients are at a higher risk for suicide. This article discusses the spectrum Model of interventions for mental health protection proposed by Mrazek & Haggarty, B-SAFE strategy, and SAFE-T strategy. The above models portray a stepwise approach for inpatients who are “at risk” for suicide. Prevention strategies are to be specifically tailored for each individual, after carefully assessing the risk of suicide. Early diagnosis and proper treatment of psychiatric illness and modification of hospital environmental factors are the cornerstones in preventing inpatient suicides. The role of nursing and paramedical staff is also discussed.