CONCLUSION

Inpatient settings have a certain risk for suicide and self-harm among patients who may be suicidal or under stress from various causes. Though the hospital can be a place of restoration and healing, some aspects of hospital care may exacerbate suicide ideation and self-harm risk among patients. Therefore, hospitals should seek to implement guidelines that mitigate risk while still providing the patient with optimal care. While research exists to help mitigate this risk, more research and data collection is needed to find the most effective interventions. Research efforts being conducted around the world may identify measures that most effectively reduce incidences of suicide and self-harm.

AUTHOR

Christen Dunn holds a Master of Public Health degree and is pursuing a Ph.D. in Health Services Research at Old Dominion University in Norfolk, Va. Ms. Dunn’s current research interests include sleep and mental health related outcomes in a variety of populations.

REFERENCES

Australian Commission on Safety and Quality in Health Care. (2017). National Safety and Quality Health Service Standards (2 ed.). Sydney, Australia: Australian Commission on Safety and Quality in Health Care.

Avci, D., Selcuk, K. T., & Dogan, S. (2017). Suicide Risk in the Hospitalized Elderly in Turkey and Affecting Factors. Archives of psychiatric nursing, 31(1), 55-61. doi:10.1016/j.apnu.2016.08.002

Bantjes, J., Nel, A., Louw, K.-A., Frenkel, L., Benjamin, E., & Lewis, I. (2017). ‘This place is making me more depressed’: The organisation of care for suicide attempters in a South African hospital. Journal of Health Psychology, 22(11), 1434-1446. doi:10.1177/1359105316628744

Beck, A. T., Steer, R. A., & Ranieri, W. F. (1988). Scale for Suicide Ideation: psychometric properties of a self-report version. J Clin Psychol, 44(4), 499-505. doi:10.1002/1097-4679(198807)44:4<499::aid-jclp2270440404>3.0.co;2-6

Berlim, M. T., Perizzolo, J., Lejderman, F., Fleck, M. P., & Joiner, T. E. (2007). Does a brief training on suicide prevention among general hospital personnel impact their baseline attitudes towards suicidal behavior? Journal of Affective Disorders, 100(1), 233-239. doi:https://doi.org/10.1016/j.jad.2006.09.035

Betz, M. E., Wintersteen, M., Boudreaux, E. D., Brown, G., Capoccia, L., Currier, G., . . . Harkavy-Friedman, J. (2016). Reducing Suicide Risk: Challenges and Opportunities in the Emergency Department. Annals of emergency medicine, 68(6), 758-765. doi:10.1016/j.annemergmed.2016.05.030

Birkbak, J., Stuart, E., Lind, B., Qin, P., Stenager, E., Larsen, K., . . . Erlangsen, A. (2016). Psychosocial therapy and causes of death after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching. Psychological Medicine, 46(16), 3419-3427. doi:10.1017/S0033291716001872

Carroll, R., Metcalfe, C., & Gunnell, D. (2014). Hospital presenting self-harm and risk of fatal and non-fatal repetition: systematic review and meta-analysis. PLoS One, 9(2), e89944-e89944. doi:10.1371/journal.pone.0089944

Chauliac, N., Leaune, E., Gardette, V., Poulet, E., & Duclos, A. (2019). Suicide Prevention Interventions for Older People in Nursing Homes and Long-Term Care Facilities: A Systematic Review. Journal of geriatric psychiatry and neurology, 891988719892343. doi:10.1177/0891988719892343

Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide Rates After Discharge From Psychiatric Facilities: A Systematic Review and Meta-analysis. JAMA psychiatry, 74(7), 694-702. doi:10.1001/jamapsychiatry.2017.1044

Claassen, C. A., Pearson, J. L., Khodyakov, D., Satow, P. M., Gebbia, R., Berman, A. L., . . . Insel, T. R. (2014). Reducing the burden of suicide in the U.S.: the aspirational research goals of the National Action Alliance for Suicide Prevention Research Prioritization Task Force. American Journal of Preventive Medicine, 47(3), 309-314. doi:10.1016/j.amepre.2014.01.004

Comprehensive Accreditation Manual for Hospitals. (2017). In Sentinel Events (SE): The Joint Commission

Conwell, Y., Van Orden, K., & Caine, E. D. (2011). Suicide in Older Adults. Psychiatric Clinics of North America, 34(2), 451-468. doi:https://doi.org/10.1016/j.psc.2011.02.002

Couillet, A., Terra, J.-L., Brochard, N., & Chauliac, N. (2017). Barriers to the prevention of suicide in nursing homes: A qualitative study of the social representations of caregivers. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 38(6), 423-432. doi:10.1027/0227-5910/a000466

de Beurs, D., Vancayseele, N., van Borkulo, C., Portzky, G., & van Heeringen, K. (2018). The association between motives, perceived problems and current thoughts of self-harm following an episode of self-harm. A network analysis. Journal of Affective Disorders, 240, 262. doi:10.1016/j.jad.2018.07.047

Donald, M., Dower, J., & Bush, R. (2013). Evaluation of a Suicide Prevention Training Program for Mental Health Services Staff. Community Mental Health Journal, 49(1), 86-94. doi:10.1007/s10597-012-9489-y

Grant, C. L., & Lusk, J. L. (2015). A multidisciplinary approach to therapeutic risk management of the suicidal patient. Journal of multidisciplinary healthcare, 8, 291-298. doi:10.2147/JMDH.S50529

Graves, J. M., Mackelprang, J. L., Van Natta, S. E., & Holliday, C. (2018). Suicide Prevention Training: Policies for Health Care Professionals Across the United States as of October 2017. American Journal of Public Health, 108(6), 760-768. doi:10.2105/AJPH.2018.304373

Haney, E. M., O’Neil, M. E., Carson, S., Low, A., Peterson, K., Denneson, L. M., . . . Kansagara, D. (2012). VA Evidence-based Synthesis Program Reports. In Suicide Risk Factors and Risk Assessment Tools: A Systematic Review. Washington (DC): Department of Veterans Affairs (US)

Hawton, K., Bergen, H., Cooper, J., Turnbull, P., Waters, K., Ness, J., & Kapur, N. (2015). Suicide following self-harm: findings from the Multicentre Study of self-harm in England, 2000-2012. Journal of Affective Disorders, 175, 147. doi:10.1016/j.jad.2014.12.062

Horrocks, J., Price, S., House, A., & Owens, D. (2003). Self-injury attendances in the accident and emergency department: Clinical database study. Br J Psychiatry, 183, 34-39. doi:10.1192/bjp.183.1.34

James, K., Stewart, D., & Bowers, L. (2012). Self-harm and attempted suicide within inpatient psychiatric services: A review of the Literature. International Journal of Mental Health Nursing, 21(4), 301-309. doi:10.1111/j.1447-0349.2011.00794.x

Kendall, T., Taylor, C., Bhatti, H., Chan, M., & Kapur, N. (2011). GUIDELINES: Longer term management of self harm: summary of NICE guidance. BMJ: British Medical Journal, 343(7834), 1167-1169

Koweszko, T., Gierus, J., Mosiołek, A., Kamiński, M., Janus, M. D., & Szulc, A. (2016). The Development and the Structure of the Verbal Suicide Scale (VSS) – Measuring Attitudes Toward Suicide in the Group of Patients Hospitalized in the Psychiatric Unit. Archives of psychiatric nursing, 30(4), 476-479. doi:10.1016/j.apnu.2016.06.004

Litteken, C., & Sale, E. (2018). Long-Term Effectiveness of the Question, Persuade, Refer (QPR) Suicide Prevention Gatekeeper Training Program: Lessons from Missouri. Community Mental Health Journal, 54(3), 282-292. doi:10.1007/s10597-017-0158-z

Matthay, E. C., Farkas, K., Skeem, J., & Ahern, J. (2018). Exposure to Community Violence and Self-harm in California: A Multilevel, Population-based, Case-Control Study. Epidemiology (Cambridge, Mass.), 29(5), 697-706. doi:10.1097/EDE.0000000000000872

Mezuk, B., Ko, T. M., Kalesnikava, V. A., & Jurgens, D. (2019). Suicide Among Older Adults Living in or Transitioning to Residential Long-term Care, 2003 to 2015. JAMA Network Open, 2(6), e195627-e195627. doi:10.1001/jamanetworkopen.2019.5627

Mezuk, B., Rock, A., Lohman, M. C., & Choi, M. (2014). Suicide risk in long-term care facilities: a systematic review. International journal of geriatric psychiatry, 29(12), 1198-1211. doi:10.1002/gps.4142

Mills, P. D., King, L. A., Watts, B. V., & Hemphill, R. R. (2013). Inpatient suicide on mental health units in Veterans Affairs (VA) hospitals: avoiding environmental hazards. General Hospital Psychiatry, 35(5), 528-536. doi:10.1016/j.genhosppsych.2013.03.021

Mills, P. D., Watts, B. V., Miller, S., Kemp, J., Knox, K., DeRosier, J. M., & Bagian, J. P. (2010). A Checklist to Identify Inpatient Suicide Hazards in Veterans Affairs Hospitals. The Joint Commission Journal on Quality and Patient Safety, 36(2), 87-93. doi:https://doi.org/10.1016/S1553-7250(10)36015-6

Murphy, B. J., Bugeja, L. C., Pilgrim, J. L., & Ibrahim, J. E. (2018). Suicide among nursing home residents in Australia: A national population-based retrospective analysis of medico-legal death investigation information. International journal of geriatric psychiatry, 33(5), 786-796. doi:10.1002/gps.4862

National Institute for Health and Care Excellence. (2013). Self-Harm. In (Vol. QS34)

National Institute for Health and Care Excellence. (2019). Suicide. In (Vol. QS189)

Navin, K., Kuppili, P. P., Menon, V., & Kattimani, S. (2019). Suicide Prevention Strategies for General Hospital and Psychiatric Inpatients: A Narrative Review. Indian Journal of Psychological Medicine, 41(5), 403-412. doi:10.4103/IJPSYM.IJPSYM_169_19

Neimeyer, R. A., & Maclnnes, W. D. (1981). Assessing paraprofessional competence with the Suicide Intervention Response Inventory. Journal of Counseling Psychology, 28(2), 176-179. doi:10.1037/h0077970

Neimeyer, R. A., & Pfeiffer, A. M. (1994). Evaluation of suicide intervention effectiveness. Death Stud, 18(2), 131-166. doi:10.1080/07481189408252648

O’Riley, A., Nadorff, M. R., Conwell, Y., & Edelstein, B. (2013). Challenges Associated With Managing Suicide Risk in Long-Term Care Facilities. The annals of long-term care : the official journal of the American Medical Directors Association, 21(6), 28-34

Olfson, M., Marcus, S. C., & Bridge, J. A. (2012). Emergency Treatment of Deliberate Self-harm. Archives of General Psychiatry, 69(1), 80-88. doi:10.1001/archgenpsychiatry.2011.108

Park, C. H. K., Lee, J. W., Lee, S. Y., Moon, J., Shim, S.-H., Paik, J.-W., . . . Ahn, Y. M. (2017). Comparison of Baseline Characteristics between Community-based and Hospital-based Suicidal Ideators and Its Implications for Tailoring Strategies for Suicide Prevention: Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior. Journal of Korean Medical Science, 32(9), 1522-1533. doi:10.3346/jkms.2017.32.9.1522

Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., . . . Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. The American Journal of Psychiatry, 168(12), 1266-1277. doi:10.1176/appi.ajp.2011.10111704

Reiter-Theil, S., Wetterauer, C., & Frei, I. A. (2018). Taking One’s Own Life in Hospital? Patients and Health Care Professionals Vis-à-Vis the Tension between Assisted Suicide and Suicide Prevention in Switzerland. International journal of environmental research and public health, 15(6). doi:10.3390/ijerph15061272

Reuter Morthorst, B., Soegaard, B., Nordentoft, M., & Erlangsen, A. (2016). Incidence Rates of Deliberate Self-Harm in Denmark 1994–2011. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 37(4), 256-264. doi:10.1027/0227-5910/a000391

Riblet, V. N., Shiner, R. B., Watts, R. B., Mills, R. P., Rusch, R. B., & Hemphill, R. R. (2017). Death by Suicide Within 1 Week of Hospital Discharge: A Retrospective Study of Root Cause Analysis Reports. The Journal of Nervous and Mental Disease, 205(6), 436-442. doi:10.1097/NMD.0000000000000687

Russ, M. (2016). Constant Observation of Suicidal Patients: The Intervention We Love to Hate. Journal Of Psychiatric Practice, 22(5), 382-388. doi:10.1097/PRA.0000000000000175

Sanne, T., Aartjan, B., Jens, A., Sabine, J., Martin, S., & Renske, G. (2018). Suicide prevention gatekeeper training in the Netherlands improves gatekeepers’ knowledge of suicide prevention and their confidence to discuss suicidality, an observational study. BMC public health, 18(1), 1-8. doi:10.1186/s12889-018-5512-8

Stanley, B., & Brown, G. K. (2012). Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk. Cognitive and Behavioral Practice, 19(2), 256-264. doi:https://doi.org/10.1016/j.cbpra.2011.01.001

Substance Abuse and Mental Health Services Administration. (2015). Promoting Emtional Health and Preventing Suicide: A Toolkit for Senior Citizens. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration

The Joint Commission. (2020). National Patient Safety Goals Effective July 2020 for the Hospital Program. In NPSG.15.01.01 (Vol. 15.01.01): The Joint Commission

Townsend, E., Ness, J., Waters, K., Kapur, N., Turnbull, P., Cooper, J., . . . Hawton, K. (2016). Self-harm and life problems: findings from the Multicentre Study of Self-harm in England. Social Psychiatry and Psychiatric Epidemiology, 51(2), 183-192. doi:10.1007/s00127-015-1136-9

Walsh, G., Sara, G., Ryan, C. J., & Large, M. (2015). Meta-analysis of suicide rates among psychiatric in-patients. Acta Psychiatrica Scandinavica, 131(3), 174-184. doi:10.1111/acps.12383

Wang, D. W. L., & Colucci, E. (2017). Should compulsory admission to hospital be part of suicide prevention strategies? BJPsych bulletin, 41(3), 169-171. doi:10.1192/pb.bp.116.055699

Watts, B. V., Shiner, B., Young-Xu, Y., & Mills, P. D. (2016). Sustained Effectiveness of the Mental Health Environment of Care Checklist to Decrease Inpatient Suicide. Psychiatric Services, 68(4), 405-407. doi:10.1176/appi.ps.201600080

Wilhelm, K., Korczak, V., Tietze, T., & Reddy, P. (2017). Clinical pathways for suicidality in emergency settings: a public health priority. Australian Health Review, 41(2), 182-184. doi:10.1071/AH16008

Williams, S. C., Schmaltz, S. P., Castro, G. M., & Baker, D. W. (2018). Incidence and Method of Suicide in Hospitals in the United States. Joint Commission Journal on Quality and Patient Safety, 44(11), 643-650. doi:10.1016/j.jcjq.2018.08.002

World Health Organization. (2014). Preventing Suicide: A Global Imperative. Geneva, Switzerland: WHO Press.

Wortzel, H. S., Matarazzo, B., & Homaifar, B. (2013). A model for therapeutic risk management of the suicidal patient. J Psychiatr Pract, 19(4), 323-326. doi:10.1097/01.pra.0000432603.99211.e8

 

Download PDF copy of the document