Suicide precautions for psychiatric inpatients: a review

This paper reviews the literature on the assessment and management of suicide risk of psychiatric inpatients. Even though a large number of scales have been developed to assist the prediction of suicide for patients admitted for suicide ideas and attempts, none of them were designed to predict suicide in the short term. However the Modified Suicide Intent Scale and the Hopeless-ness Scale appear to have the potential to predict immediate suicide risk. Risk factors associated with specific psychiatric conditions were all derived retrospectively and their predictive validities have not been established by prospective studies. Important issues relating to the management of suicidal inpatients, such as staff-patient relationships, use of constant observation and medical-legal aspects are reviewed. Australian and New Zealand Journal of Psychiatry 1992; 26:592-598 Most suicides do not occur within hospitals. Only 0.5 % of all suicides in the US. occur in general hospital [ 11. In the U.K. 5 % of all suicides occur among hospital inpatients [2]. However the suicide rate in hospital is often much higher than that of the general population [3,4,5,6]. There has been a recent increase in the rate of inpatient suicides [2,4]. Inpatient suicides are well known to generate tremendous staff anxiety, guilt and other distressing reactions [7,8]. It also often leads, at least in the US, to litigation involv-ing the hospital and staff concerned. Parker [9] and Cantor [ 101 have recently discussed future trends in litigation for suicides during psychiatric care in Australia. Unfortunately psychiatrists are not good at assessing the imminent suicide risk [ 11,121. The as-sessment of suicide risk is often done at a clinical-in