FACTORS COMPLICATING COST-CONTAINMENT IN THE TREATMENT OF SUICIDAL PATIENTS

Objective: The treatment of suicidal patients contributes to escalatin g mental health expenditures. Fiscal realities necessitate that cost-c ontainment measures be implemented wherever possible. The authors revi ewed the literature to delineate factors that impede cost containment for the treatment of suicidal patients and to outline strategies for c ontrolling costs while improving the quality of care. Methods: Psychol ogical Abstracts and MEDLINE databases were reviewed. Retrieval and an alysis focused on literature published between 1982 and 1992. Results and conclusions: Five factors unique to the treatment of suicidal pati ents that impede cost containment were identified. the lack of a speci fic and cost-effective screening method to determine true risk of suic ide, the high number of parasuicidal and malingering patients, revolvi ng-door admissions of involuntary patients who become noncompliant wit h treatment after discharge, the adverse clinical consequences of furt her increases in existing discriminatory mental health benefits, and t he medicolegal liability incurred in treating suicidal patients, The l ow frequency of completed suicides in relation to attempts and reporte d ideation indicates that most inpatients labeled suicidal are hospita lized unnecessarily. Thus inpatient treatment should be reserved for p atients who make attempts of high lethality and patients with suicidal ideation who are at high risk because of other factors. Ideally, suic idal patients should be committed not to an inpatient facility but to a treatment network in which they can move appropriately between inpat ient, day hospital, and outpatient care.