SUICIDE AMONG PSYCHIATRIC-INPATIENTS IN A CHANGING CLINICAL SCENE - SUICIDAL IDEATION AS A PARAMOUNT INDEX OF SHORT-TERM RISK

Background Rapid changes in styles of clinical practice mean that we s hould carefully monitor the way suicides occur among psychiatric patie nts both in hospital and in the wider community. Method Patients who h ad died through suicide either while receiving in-patient care or with in 2 months of discharge from hospital were compared with a similar se ries reported 10 years previously. Clinicians' perceptions of patients ' behaviour were compared with concurrent controls. Results Patients i n the more recent study were younger, more often male, and a greater p roportion had been discharged from in-patient status. Hazards which co mplicated risk assessment included short-lasting misleading clinical i mprovements, variability in degree of distress, and a reluctance to di scuss. suicidal ideas. Over a range of perceived behaviours it was not possible to distinguish suicides from controls. Conclusions In assess ing suicide risk paramount importance should be attached to monitoring suicidal ideation and addressing the several hazards which might comp licate this procedure.