Suicid blant innlagte psykiatriske pasienter Betydningen av tap, avvisning og krenkelse belyst ved klinisk materiale

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Abstract
Alnæs R. Suicide among psychiatric inpatients. The importance of loss, rejection and injury. The number of suicides is increasing in psychiatric wards. Twenty-one suicides in hospital during the years 1959-88 are analysed. Explanations for the rise in suicide rate are discussed: increased admittance of patients with more severe psychopathology, rise in circulation of patients, increased turnover of personnel, side effects of milieu therapy, and a liberal open-door policy. Case histories are presented for illustration of the material. Implications of the study for preventing suicides are presented. Priority should be given to a better prediction of a high risk of suicide from a psychodynamic point of view, especially by considering rejection, loss, separation, and conflicts generating suicidal processes. The importance of regression phenomena in the patients and countertransference problems of the ward personnel preceding the suicide are underlined. The documented increase in more severe psychopathology among inpatients compared with earlier years and the administrative changes present a greater challenge for the staff. It would be of importance to improve diagnostic competence, psychologic education, and supervision.