The Most Dangerous Time: Suicide After Discharge from a Psychiatric Hospital

There are many characteristics that place a person at higher risk for suicide – depression, substance use, a prior suicide attempt, as examples.  It is important for clinicians to know that an especially dangerous characteristic, one that exponentially increases the chances of suicide, is recent discharge from a psychiatric hospital.

I am at the Aeschi West conference this week in Vail, CO. Sponsored by the Mayo Clinic, it is a meeting of 70 or so mental health professionals from around the world who work extensively with suicidal clients. Here, we learn from the best and share our own experiences with other clinicians who have a passion for preventing suicide.

David Rudd, a nationally known suicide expert, gave an excellent presentation about warning signs and risk factors for suicide. He reviewed research showing that in the week following discharge from a psychiatric hospital, people are at dramatically high risk for suicide. One study found that women were 246 times more likely than would be expected – and men were 102 times more likely – to die by suicide in that crucial week. Chances of suicide remain markedly high for at least a month following discharge from a psychiatric hospital.

As Dr. Rudd notes, the elevated risk for suicide following hospitalization does not necessarily mean that the patient was discharged in error. Instead, suicidal intent is fluid, impossible to predict from one moment to the next, let alone day to day. Of course, whatever led to hospitalization in the first place, whether a suicide attempt, mental illness, or some other crisis, places a person at higher risk than normal for suicide.

So What Should a Clinician Do During this Period of Danger?

Dr. Rudd recommends seeing your therapy client at least twice in the week after discharge. Importantly, he states that the first session should, whenever possible, occur on the same day as discharge.

This is one of the most practical pieces of advice ever on preventing suicide, one that has the potential to save many lives.

 

© Copyright 2013 Stacey Freedenthal, PhD, LCSW, All rights Reserved. Written For: Speaking of Suicide

Photo purchased from Fotolia.com

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  1. Melanie E. Evans says:

    I can’t believe that the psychiatric branch of medicine thinks they have a right to justify trampling the rights of those with psychiatric issues by putting them on a hold for suicidal indeations when they are likely to commit suicide when they leave the hospital. This isn’t right! In any other branch of medicine, patients are allowed to refuse treatment. Those with psychiatric issues should be no different. It is high time that you stopped treating us like children. That you stopped treating us like less.

    Our rights are trampled all the time once we are diagnosis-ed with emotional, behavioral, intellectual and other mental disabilities. There are supposed to be laws to protect us, but they are a JOKE! the agencies that are supposed to protect our rights refuse to even take our complaints. the law only looks at our medical records to decide if our rights were violated. They only look at our medical records to decide if we were neglected, mistreated, abused or assaulted. Why don’t they just admit that they don’t give a fuck about us?

    We should have the right to not be locked up against our will for suicidal thoughts/ideations or gravely disabled.
    We should have the right not be forced or coerced into taking psychiatric medications.
    We should not be forced or coerced into taking medication in a psychiatric hospital no matter the circumstances.
    Every psychiatric patient should have advance directives for medical emergencies, psychiatric problems and psychiatric emergencies. They should be able to decide what is done in an emergency. Decide whether staff uses restraints or medications.
    They should randomly send in people to investigate psychiatric hospitals as homeless patients with no or bad insurance.
    All complaints by psychiatric patients should be taken seriously!

    We Are Human Beings!

    • Anonymous says:

      Thank you for exposing them. I’ve gotten a lot worse since being in one. They purposely try to intimidate you to give you more medication, or to rest your symptoms. You literally have to play “their game” to ever be let out. The issue is all they know is school, and seeing patients, but they will never be able to truly empathize with their patients. There is a difference between our feelings, and our plans of action. They fail to realize that thoughts are thoughts.

    • Jesse says:

      You’re amazing for exposing a disgusting system. School has nothing to do with emapathizing with suffering humans. “Doctor” or not. I’m 100% sure I can productively support a suicidal individual more than a system that uses threats, manipulation, and harassment as there ways of “regulating” us. Pathetic system. Those hospitals see everything as a do or die so that they aren’t liable if something were to happen to us while there. Fucking disgusting. No sense of empathy whatsoever, it’s all about looking at the worst case scenario for them. They fail to realize thoughts aren’t the same as courses of action. That’s what makes us fear exposing our whole truth. Being locked away as another test subject. Losing yourself more and more each time. Mental health is a joke to everyone who Isn’t suffering, especially college professors. Sad to think these are the people we’re supposed to trust the most, yet they think they understand our perspective just with our language. I mean fuck, how is someone not supposed to feel hopeless when we’re all just a joke to these scholars. I don’t understand how studying books makes them qualified. The reasearch isn’t based on every suffering human. We’re all so different.

      • Stacey Freedenthal, PhD, LCSW says:

        Jesse,

        You raise many good points. I’m curious, why do you assume that no professors or other professionals suffer from mental illness, trauma, or other sources of profound emotional pain? I can only wish that were so.

  2. Thea Amidov says:

    Why is the risk of suicide so heightened shortly after release from a hospital? I have heard this statistic many times, but never is there any explanation offered. Is it because the post traumatic stress from the hospitalization?
    Is it because of pent up interest in suicide during hospitalization, suggesting that the hospitalization did nothing to reduce the death wish? It surely doesn’t recommend the ward experience.

    • Nemo says:

      Speaking from experience I would say there were a couple of reasons why for me. I was forced into going and to get me to calm down they lied to my face about how the charges would work. They make you wait forever to get in and make you feel subhuman through the whole process. Once in you have zero privacy for obvious reasons, but it still doesn’t help quiet the mind. They stick you in with all sorts of people with numerous issues, some of which are violent. This gave me a certain amount of empathy for people in their position, but it does a number on the psyche. Sleeping is a nightmare sometimes with people screaming well into the night many nights. They strip you of most forms of passing the time and days can drag on. The main form of diversion is to introvert into your own mind which isn’t great if you are suicidal. They generally start you on meds and that can be extremely trying especially when there are unwanted effects. They also don’t seem to have the same sanitary standards as the rest of the hospital with many areas becoming a mess and staying that way through the two weeks I was there. The resident who used my bed before me apparently had scabies and they obviously didn’t clean the bed because I wound up with scabies after my stay. I wouldn’t wish scabies on the worst of my enemies (except maybe the hospital staff). Then for the cherry on top, bills. I was there for two weeks for what was basically a stay at a crappy hotel and got a bill of over 100k. Even with insurance I still had to pay 7k. They were also ruthless in getting that money. I wasn’t even close to attempting before they forced me in, but while there and for a while after getting out I was always on the edge of suicide. While I was there i even thought of ways to kill myself while there just to spite them. It was a miracle I didn’t actually kill myself. So the only things that the hospital gave me for over 100k were a higher degree of empathy, a paranoia and hatred surrounding the medical industry, scabies, and a more suicidal mindset. I have sworn to never go near a hospital again regardless the reason.

      • Melanie E. Evans says:

        I know what you are talking about. I was put on an illegal hold too. I was picked on, bullied, neglected and physically assaulted by staff. I almost killed myself two days after leaving the hospital when I had no intention of trying to kill myself before my sociopathic therapist put me on the illegal hold and had me abused.

    • Melanie E. Evans says:

      Many patients are abused while they are in a psychiatric hospital.
      example: I was put on an illegal hold for suicidal thoughts even though I didn’t want to kill myself. I just needed someone to talk about because of recent sexual assault and how badly law enforcement and the courts treated me. While I was in the hospital, I was picked on, bullied, neglected by, abused and physically assaulted by staff. I was extremely suicidal when I left. I came very close to killing myself two days after I left the hospital.
      We are treated like animals in the hospitals. They try to force and/or coerce us into taking psychiatric medications with no thought to past bad experiences with them. They treat you like children all day long. There are always at the very least at least on patient who staff us as a target for picking on and bullying.
      Then, the authorities only look at your medical records from you hospital stay to decide if you were mistreated. They should just say that they don’t give a fuck about us.

  3. . says:

    Why are you avoiding making the most obvious connection: Involuntary hospitalization is traumatic and is a catalyst for suicide. Maybe when a treatment method leads to a 10,000% or 20,000% increase in mortality, you should stop doing it?

    Really, why is this still an option on the table? It clearly does not work as intended.

    • Melanie E. Evans says:

      Excellent Question
      Holds for suicidal thoughts/indentations and gravely disabled should be illegal! They just trample our rights!

  4. Mari says:

    Stop traumatizing the patients. The most important aspect for a person considering suicide is control. They do not feel that they are in control of their lives, and you take even more of it away. You make prisoners without any real appeal. In Federal Prison they cannot experiment with drugs on the prisoners it is unconstitutional. How the hell do you get away with it?

    • Stacey Freedenthal, PhD, LCSW says:

      Mari, I understand your concerns about the traumatizing effects of involuntary hospitalization. I share many of these same concerns.

      You ask, “How the hell do you get away with it?” Speaking personally, I want to clarify that I have not yet had to seek involuntary commitment of a client, and, as a clinical social worker, I cannot prescribe drugs.

      Speaking more generally, I want to clarify that involuntary patients are not “prisoners without any real appeal.” To the contrary, in the United States each state has specific regulations pertaining to involuntary commitments. These regulations allow for circumscribed periods during which a person can be held, processes for appeal by the patient, provision of attorney representation, etc.

      This handout of Frequently Asked Questions about involuntary commitment contains some useful information: Involuntary Treatment: Hospitalization and Medications, by John Menninger, M.D.

      • B says:

        I don’t know how it is in US but I’ve seen how these legal safeguards work in other countries. The moment you’re labelled crazy without insight you lose all human rights and the judges are basically rubberstamping whatever the “good professionals” tell them. Sure, some people manage to sue their way out but it takes years and their lives are usually destroyed.

      • Melanie E. Evans says:

        That’s a LIE!
        They never look at whether you should of been on a hold in the first place? The best you can hope for is to be let out of the hospital and you just have to accept losing some of your rights for 5 years after you leave!
        They only look at your medical records for the hospital stay to decide whether you were mistreated in the hospital. To decide if you where picked on, bullied, neglected, abused, assaulted or in any other way had your rights violated. They should just admit that they don’t give a fuck about us!
        The agencies that are supposed to protect our rights won’t even take our complaints.
        The police will not take a report for assault.
        We are constantly coerced and bullied by all branches of medicine once they find out that we have psychiatric issues!
        We Are Human Beings!
        Stop Trampling Our Rights!

    • Melanie E. Evans says:

      Because most people only see us as a burden on society with nothing to offer!

  5. Amy fink says:

    I have been borderline bi polar for 40 yrs, medicated. I am still “moody”.who isn’t when things are bad in life. I have never hurt myself in any way, if anyone else. I don’t drink, or do drugs. Some days I have just ” had enough” and therapist is threatening me with hospital. That is wrong. I am safer alone with my DOG. If I should refuse, what can I legally do about it? It is after all MY CHOICE!

  6. Cynthia says:

    My father committed suicide 25 mins after hospital discharge that very day told a few health care workers he couldn’t live this way one PA scolded him for talking that way in front of my sister and myself he had just learned he had inoperative cancer his doctor changed his fentanyl patch from 25 to 75 and discharged him after all his comments and his diagnose why was a psych dr not called instead he was sent home only to die within. 30 mins I feel the hospital failed him

    • Mari says:

      I am deeply sorry for your loss Cynthia. My father died of inoperative cancer many years ago. His suffering was so great…he only stayed alive for the sake of my mother held on for almost a year. We were all glad for him when it was finally over. I loved him deeply. Give yourself time honey, give yourself time. grief will have its say.

  7. b says:

    How about suicide being caused by the hospitalisation and received treatment? Psychiatrists tend to deny that many practices used on people in these institutions are harmful and can cause PTSD: forced drugging, restraints, strip searches, seclusion, threats by the staff. These practices have been declared as torture/inhuman and degrading treatment by UN but that hasn’t stopped their use.

  8. Carol F. says:

    Wow. This hit home for me. My 23-year-old daughter, Alison, was hospitalized for depression, anxiety, and suicidal ideations on July 22, 2013. She was released into IOP and discharged on August 26. Two days later, she jumped from a parking garage and ended her life. In her final weeks, she made sure to spend time with each member of her family. The night before she died, we spent the entire night together, watching TV, drinking tea, and just enjoying being in each other’s presence. I thought at the time that she was feeling better, evidenced by the fact she was spending more time with us. Looking back, I wish I had realized she was saying goodbye.

    • Stacey Freedenthal, PhD, LCSW says:

      Carol F., how devastating to lose your daughter, especially when it seemed she was doing better and getting the help that she needed. Have you been able to connect with other survivors? There are survivor support groups that may be of help, whether online or in person. You can find resources here: http://www.speakingofsuicide.com/resources/#survivors

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