OBJECTIVE:The treatment of suicidal patients contributes to escalating mental health expenditures. Fiscal realities necessitate that cost-containment measures be implemented wherever possible. The authors reviewed the literature to delineate factors that impede cost containment for the treatment of suicidal patients and to outline strategies for controlling costs while improving the quality of care.METHODS:Psychological Abstracts and MEDLINE databases were reviewed. Retrieval and analysis focused on literature published between 1982 and 1992.RESULTS AND CONCLUSIONS:Five factors unique to the treatment of suicidal patients that impede cost containment were identified: the lack of a specific and cost-effective screening method to determine true risk of suicide, the high number of parasuicidal and malingering patients, revolving-door admissions of involuntary patients who become noncompliant with treatment after discharge, the adverse clinical consequences of further increases in existing discriminatory mental health benefits, and the medicolegal liability incurred in treating suicidal patients. The low frequency of completed suicides in relation to attempts and reported ideation indicates that most inpatients labeled suicidal are hospitalized unnecessarily. Thus inpatient treatment should be reserved for patients who make attempts of high lethality and patients with suicidal ideation who are at high risk because of other factors. Ideally, suicidal patients should be committed not to an inpatient facility but to a treatment network in which they can move appropriately between inpatient, day hospital, and outpatient care.

Research shows that most involuntary commitments conform to legal criteria and that psychiatrists generally agree on which patients should be committed. There are many cases, however, that cause disagreement among psychiatrists making commitment decisions. No research has been done regarding types of cases causing disagreement. The authors developed 10 clinical vignettes termed "ambiguous case constructs" that could be proven to be indeterminate and explore what underlying themes these indeterminate cases might hold in common. A pilot study was conducted to develop a set of 10 clinical vignettes, which were found to be representative of psychiatric emergencies and likely to cause discordance among evaluating psychiatrists. These validated vignettes were then presented to 62 psychiatrists who were asked to determine the commitment disposition for each vignette patient. Seven of these vignettes elicited significant disagreement among respondents and were identified as indeterminate cases. The frequency and percentage of psychiatrists endorsing commitment for each vignette is listed. This study validates the existence of indeterminate cases which prompt disagreement among psychiatrists making commitment decisions. Upon retrospective review, disagreement evoked by the seven indeterminate cases is proposed to have originated from one of four themes. The implications for clinical practice are noted.

Back to table of contents Previous article Next article ArticleNo AccessSuicide ContagionDavid A. FishbainDavid A. FishbainSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.42.1.94AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Suicide Contagion." Psychiatric Services, 42(1), pp. 94–95 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByNone Volume 42Issue 1 January 1991Pages 94-95 Metrics PDF download History Published online 1 April 2006 Published in print 1 January 1991

Back to table of contents Previous article Next article ArticleNo AccessInpatient Suicide Epidemics and Suggestions for PreventionDavid J. Rissmiller, and Frances RissmillerDavid J. Rissmiller, and Frances RissmillerPublished Online:1 Apr 2006https://doi.org/10.1176/ps.41.8.922AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail PDFThis content is only available as a PDF. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByPsychological Aposematism: An Evolutionary Analysis of Suicide25 May 2020 | Biological Theory, Vol. 15, No. 4Suicide clustering in a psychiatric hospital with a history of a suicide epidemic: a quantitative study1 April 2006 | American Journal of Psychiatry, Vol. 151, No. 7The Healing Process for the Multidisciplinary Team: Recovering Post-Inpatient SuicideJournal of Psychosocial Nursing and Mental Health Services, Vol. 32, No. 2 Volume 41Issue 8 August 1990Pages 922-924 Metrics PDF download History Published online 1 April 2006 Published in print 1 August 1990