How to Reduce Suicide in the Psychiatric Ward

Over the last decade, more than 50 people have died by suicide while admitted to psychiatric facilities in California. The figure paints a bleak picture of the options available for people in the midst of a mental health crisis.

So for families whose loved ones are suffering from suicidal thoughts, is there hope? Can hospitals actually stop people from dying by suicide?
The short answer, experts say, is yes.

Suicide rates have risen in nearly every state in America over the last 20 years. Nationwide, suicide is an epidemic, now the second-leading cause of death among people ages 10 to 35.

Psychiatric hospitals are often seen as a last resort for people who are suicidal. But a Times analysis found that over the last decade, nearly 100 people died while admitted to these facilities in California, mostly due to suicide. A study released last year found that nationwide 49 to 65 people die by suicide annually while in the hospital.

But there is wide variation in suicide rates from hospital to hospital, suggesting some places are keeping patients safer than others. One of the high-performing systems, the Department of Veterans Affairs, offers some clues as to what might work.

In 2007, VA hospitals nationwide adopted a 134-question checklist designed to reduce suicide risks for patients.

Staff members must ensure that pillows and mattresses are free of vinyl or plastic, which could be used for strangulation; that there are no privacy curtains, which can be used for hanging; that all exits and entrances to the building are within the line of sight of the nurses’ station, so patients are easily monitored.

Since the checklist was implemented, suicides in mental health units have decreased dramatically. The suicide rate fell from 4.2 suicides per 100,000 admissions to 0.74 suicides per 100,000 admissions, according to a 2016 paper.

And it has stayed down, researchers found.

“The trend suggests that the rate of suicide continues to decline since implementation of the checklist,” the paper found.

But outside the VA system, there’s been little progress, experts say.

The Joint Commission, a nonprofit that accredits most of the nation’s psychiatric hospitals, has been trying to reduce suicide rates nationwide for the last decade, to no avail, , said Dr. David Baker, the agency’s executive vice president for healthcare quality evaluation.

Part of the problem is that reliable data weren’t available on the number of suicides in hospitals and how they were taking place. The agency commissioned a study that found that among the roughly 50 suicides per year in hospitals nationwide, 70% were via hanging. Half were in the bathroom and a third in the bedroom, the study found.

In response to the findings, an expert panel made recommendations on how to limit these deaths, including the best way to monitor suicidal patients.

At many hospitals, patients deemed suicidal are put on 15-minute watch, but that isn’t very effective because it doesn’t take long to complete suicide, experts say.

“It’s certainly not the best way to monitor for suicidal ideation,” said Dr. Tyler Jones, clinical associate psychiatry professor at Oregon Health and Science University. “The opportunity can happen pretty quickly.”

The better, though more resource-intensive, option is one-to-one observation, in which a staff member is within arm’s-reach of a patient at all times.

Los Angeles Times
To read this article in its entirety CLICK HERE.