Management of the repeatedly suicidal patient

A Study of the Relationship between the Patterns of Planned Activity and Incidents of Deliberate Self-Harm within a Regional Secure Unit

Within a 77-bed Regional Secure Unit, there has been an increase in the number of patients admitted who deliberately do themselves harm, although this Is generally not the primary reason for admission. During this 9-month study, 307 incidents of self-harm were recorded on the clinic's information system; a subgroup of seven patients was responsible for 77.5% of these incidents.

Whilst there is a perception among rehabilitation staff that activity has a role in reducing the incidence of deliberate self-harm, this study Identifies no correlation between the patterns of structured activity and the patterns of deliberate self-harm. This does not suggest, however, that occupational therapy is ineffective with this client group, particularly given the potentially addictive nature of deliberate self-harm behaviour even after problem resolution. The study identifies areas for further research, focusing on qualitative rather than quantitative study.

Changing selves in changing worlds: youth suicide on the fault-lines of colliding cultures

What does it mean to somehow override change and to count one's self as one and the same individual, continuous in time? What does "continuity" mean for whole cultural groups? How might disruptions to a sense of personal or cultural persistence deprive us of a past, and a connection to our as yet unrealized futures? Why is it that the bulk of us who succeed in knitting up our raveled sleeves of care choose for life, while those who loose the thread of their continuous existence so frequently make the opposite choice? The program of research outlined here--work that explores the relation between markers of self- and cultural continuity, and suicidal behaviors in both culturally mainstream and Canadian Aboriginal youth--provides evidence that personal persistence and persistent peoples have low or absent rates of youth suicide, while individuals and communities lacking a requisite sense of continuity regularly suffer suicides in epidemic numbers.

Repetition of overdose: a retrospective 5-year study

This study investigated the number, timing and disposal (admission or discharge) of patients repeating an overdose who attended the accident and emergency department of a district general hospital during a 5-year period. There was a total of 1958 overdoses by 1597 individuals over the 5-year period. Overdoses were repeated by 12% (n = 191) of patients and accounted for 552 of the total overdoses (representing 361 repeats). First repeats were found to occur more frequently in the 3 months following the original overdose for 43% of patients, 70% of repetitions occurring within a year. The distribution of first repeats showed a similar pattern for males and females. During the 5-year period 49% of all repetitions occurred within 3 months. Almost one-fifth of repeaters were discharged, irrespective of whether it was the patient's 'index' (first overdose within the study period) or a repeat overdose. Within the repeater population, 31% of overdoses occurred on a Friday, Saturday and on, or immediately prior to, a Bank Holiday. Since there was no on-site psychiatric service available at such times, those patients had to wait until the next working day for assessment. The study recommends that all overdose patients should receive psychiatric assessment, and therefore on-site psychiatric services should be available for accident and emergency patients.

What happens to patients who frequently harm themselves? A retrospective one-year outcome study

Between 1982 and 1987, 42 patients were selected who had been admitted three times in one week to the Regional Poisoning Treatment Centre in Edinburgh for the treatment of deliberate self-harm. Most (87%) of these admissions related to drug overdose. Most of the patients were young, unemployed, lacking a partner and from the low social classes. Three-quarters of the sample had at least one known conviction and more than a third were known to have served a prison sentence. There was only one patient in whom mental illness was thought to be relevant to the episode of self-harm, although five patients were mildly mentally handicapped. Case notes were reviewed to assess the outcome one year after the index admission. None of the patients had committed suicide, although 36 repeated self-harm during the follow-up year.

Suicide risk among women with alcohol problems

The current study compares 301 alcoholic women, ages 20 to 50, interviewed in 21 treatment facilities, and a control group of nonalcoholic women matched for age and socioeconomic status of family of origin. A significantly higher percentage of alcoholic women (40.0% vs 8.8%) reported having made suicide attempts, a difference of 31.2 percentage points (95% CI = 23.9, 38.5). Age comparisons within the alcoholic sample show the percentage of younger alcoholic women attempting suicide to be twice as great as the percentage of the alcoholic women suicide attempters in their forties. Such age differences were not found among the nonalcoholic control group. The findings suggest that youthfulness and alcohol/drug abuse are the critical combination for high risk. Awareness of the suicide attempt risk potential is necessary both for emergency room personnel and for substance abuse facility workers.

Psychiatric short-stay units across Canada

The limited literature on brief hospitalization programs raised questions about the actual extent of use of this process in Canada. Inquiry was first made to all Health Ministers, University Department Heads and Section Chairmen. A questionnaire was mailed to the hospitals identified and this also requested any supplementary names of units known to the respondents. Initially, 22 hospitals were named as having short-stay units, but eight of these proved not to have one. Basic data on the 14 units actually found is provided. It is suggested that units of this type could be separated into two main groups according to the rate of discharge of patients directly into the community. Those with a high community discharge rate might be called Short-Stay Treatment Units and those with a lower community discharge rate might be known as Assessment Units. The former tend to have fewer admissions per bed, lower occupancy rates, somewhat longer LOS and location in or near the main psychiatric inpatient unit. These factors tend to be reversed in the latter.

The recurrent self-harm patient

A semistructured interview was used to collect information on a consecutive series of 163 self-harm patients (suicide attempters); 65.8% of the patients had a history of previous self-harm (repeaters). Male repeaters were more likely than men with no self-harm history (first cases) to have left school before ninth grade, to have alcohol abuse problems, and to have family stress. Female repeaters were younger than first cases and reported more difficulties with sexual adjustment and loneliness. Repeaters were more likely to have contacted distress centers and to have had previous mental health contact, including psychiatric hospitalization. A 6-month follow-up indicated four suicides in the repeaters' group and none in the first cases' group. Repeaters appear to be much more dependent than first cases on professional care and to present a high short-term risk for suicide.