Suicide among psychiatric in-patients in a changing clinical scene

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Abstract
Background: Rapid changes in styles of clinical practice mean that we should carefully monitor the way suicides occur among psychiatric patients both in hospital and in the wider community.Method: Patients who had died through suicide either while receiving in-patient care or within 2 months of discharge from hospital were compared with a similar series reported 10 years previously. Clinicians' perceptions of patients' behaviour were compared with concurrent controls.Results: Patients in the more recent study were younger, more often male, and a greater proportion had been discharged from in-patient status. Hazards which complicated risk assessment included short-lasting misleading clinical improvements, variability in degree of distress, and a reluctance to discuss suicidal ideas. Over a range of perceived behaviours it was not possible to distinguish suicides from controls.Conclusions: In assessing suicide risk paramount importance should be attached to monitoring suicidal ideation and addressing the several hazards which might complicate this procedure.