Dj. Rissmiller et al., FACTORS COMPLICATING COST-CONTAINMENT IN THE TREATMENT OF SUICIDAL PATIENTS, Hospital & community psychiatry, 45(8), 1994, pp. 782-788
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.