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.
Helping a Suicidal Person after Psychiatric Hospitalization
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.
This site is great I just found it
Anonymous, I’m happy to hear the site’s helpful to you. Thanks for sharing!
Maybe, Suicides are higher after hospitalizations because we are treated like animals with. No rights at all.
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!
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.
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.
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.
stacey, freedenthal, if there are professors suffering from mental illness, trauma, and pain (and btw, i’m pretty sure there are) it’s clearly not stopping them from abusing their patients. wether they’re mentally ill or not, there’s no excuse for their barabaric methods.
Anonymous,
Thanks for sharing here. I have to assume you’ve been hurt by therapists to call their methods barbaric, and I’m sorry you were hurt. I hope you’ll consider that there are many thousands of people in both professions. Some do harm, sure, but the vast majority I’ve encountered — both as a colleague and as a client — have been compassionate and competent. If you seek help again, I hope you have the chance to experience counseling with that kind of professional, too.
Thank you Melanie for bringing up a great point! Granted, I did have suicidal thoughts and even made several attempts, but at no time, was I ever asked if I wanted to go into a hospital. I was constantly threatened, that if I didn’t go voluntarily, I would be forced – police called, handcuffed and taken to a psychiatric hospital. I had no rights at all to refuse admission or to refuse to take psychiatric medications – however, people with other medical conditions are able to refuse treatment at any time with no second thought from medical personnel. On top of that, the hospital I was constantly admitted to was horrible. Patient abuses all over the place! 24 hours a day, 7 days a week! Now, why should I have not had the opportunity to refuse to be admitted to a place like that? We deserve the same rights as everyone else!
My nephew was literally discharged five fucking times in two months from these hospitals because they WOULDN’T keep him against his will. He jumped from a hospital balcony an hour after being discharged and died. My brother begged them to keep him there but they wouldn’t because they didn’t want to trample his ‘rights’.
You are so right . Just because you all went through similar situations…doesn’t mean the situation was the same!!Each individual went through their transgression on their own terms and deal with them individualy. Theirs no 2 same situations …”PERIOD”. If their doing that to you personally..BITCH about it…I hear ya..!!!!
I understand your anger and I do agree with Roy that no two situations are the same. However, the reason why people are calling out mental hospitals and demanding that patients have more rights is because not only have many people had horrible experiences with being involuntarily committed but often their stories get met with scorn from people who are staunchly in favor of our current mental health treatment which is, to put it mildly, not good. In fact, stories such as the one of your nephew are more likely to be listened to than these stories of abuse because it reinforces the narrative that mental hospitals are a good thing and anyone who accuses them of violating rights is a naysayer who is discouraging people from getting help. I’m also concerned with your wording. Saying “They WOULDN’T keep him against his will” as if implying they should’ve done otherwise sounds pretty harsh even if it’s for preventing suicide. As for Stacey Freedenthal’s comment, I am going to have to strongly disagree. Some individual therapists may be good, but collectively the field of therapy has been a mess in desperate need of reform and I also can’t stress enough how not everything works for everyone, including therapy.
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.
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.
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.
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.
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.
Excellent Question
Holds for suicidal thoughts/indentations and gravely disabled should be illegal! They just trample our rights!