A review of suicide within the state hospital, Carstairs 1972-1996

This retrospective case note review describes the demographic, forensic and psychiatric backgrounds of 14 in-patient suicides in a maximum secure hosp ital. The majority were schizophrenic with chronic treatment-resistant illn esses, who had committed proportionally more violent offences, had a histor y of serious self-injury but no recognized clear depressive episodes. This profile is markedly different from that reported in general psychiatric in- patients, out-patients and suicides in prison, but is similar to that descr ibed in a maximum secure hospital in the United States and in long-stay pat ients in Canada. Many of the patients had continued to experience significa ntly subjective distress over many years. The clinical relevance of this se ries is discussed in the context of the assessment of suicidal intent in ps ychotic patients. We speculate that the decrease in in-patient suicides in the State Hospital may be due to a less restrictive ward milieu, increased staff/patient ratios, or the introduction of Clozapine.