Approximately six percent of deaths by suicide in the United States occur when patients are under care in a psychiatric hospital, a mental health facility, or a mental health unit of a hospital. According to Psychiatric Times: “Inpatient suicides are viewed as the most avoidable and preventable because they occur in close proximity to staff.”
Understanding when and how these suicides occur is key to successful prevention of death by suicide. When psychiatric health professionals fail in effective monitoring and prevention, the facility where the patient was receiving treatment may be held accountable.
Understanding Death by Suicide in an Inpatient Setting
Psychiatric nurses in an inpatient facility generally experience a completed suicide every 2.5 years on average, although these suicides are widely considered the most preventable due to staff-member control of the environment and due to the greater control exercised over inpatients versus outpatients. Why? See the end of this blog.
The greatest danger to patients of death by suicide occurs in unsupervised areas, and patients are most at risk at night or during hand-offs when one staff member leaves a shift and care transfers to another healthcare worker. However, patients may die by suicide at any time when staff members fail to fulfill obligations to keep them safe.
The majority of deaths by suicide in psychiatric hospitals occur because of hanging, and 75 percent of the deaths occur in closets, bedrooms, or bathrooms of patient rooms—those hidden areas all nurses and hospital techs know about. While suicide watch protocols are aimed at preventing these fatalities, they are failing. Why? The observation period is too long. It takes approximately two minutes of hanging to have irreversible brain damage and five to six more minutes to die—either on the unit or on a respirator a few days later in another hospital where the patient has been transferred due to the emergency. When the suicide watch protocol involves checking on the patient every 15 minutes (the time interval often selected), this allows sufficient time for the patient to successfully complete a suicide. More frequent monitoring of patients at risk for suicide is called for-usually one to one (where a staff member is within arm’s length) or line of sight monitoring. In one study of patients who died by suicide in an inpatient facility, 51 percent of patients were being monitored on a 15-minute suicide observation protocol.
Inpatient facilities can also eliminate threats to patients by reducing patient access to tools and conditions which could facilitate death by suicide. For example, grab bars in showers and plumbing fixtures can be used by patients in an attempt to die by suicide. Adding plates to grab bars and putting safeguards around plumbing fixtures, like stainless steel boxes, can help to eliminate environmental risks.
Staff members must also be able to recognize when patients are at the greatest danger of death by suicide. Studies suggest in 60 percent of suicides among inpatients, the patient’s level of risk was not adequately determined by psychiatric professionals or the appropriate precautions were not taken based on the risk level identified. Professional psychiatric staff must be accurate in diagnosing the level of suicide risk posed by each patient in an inpatient facility, and appropriate protocols must be followed to protect patients from harm based on their specific risk levels.
Skip Simpson says: “In a nut shell hospitals must stop providing suicidal patients with the means, time and opportunity to kill themselves. Patient safety is not the goal for these hospitals; it is profits. Simple patient safety rules will stop the suicides if greed is put to the side.”