Magazine article Clinical Psychiatry News

Inpatient Suicide: Respond Quickly

Magazine article Clinical Psychiatry News

Inpatient Suicide: Respond Quickly

Article excerpt

TUCSON, ARIZ. -- A little more than a year ago, a young psychiatric patient scaled an 8-foot barrier on the seventh floor to jump to his death in a crowded atrium after a holiday gathering at the Mark O. Hatfield Clinical Research Center in Bethesda, Md.

The impact of the tragedy on the hospital's staff, its patients, and their families proved profound, Dr. Donald L. Rosenstein told consultation-liaison psychiatrists at the annual meeting of the Academy of Psychosomatic Medicine.

"Hospital-based suicides are rare but devastating," said Dr. Rosenstein, clinical director of the National Institute of Mental Health.

This suicide had dozens of witnesses.

Reconstructing the event and its aftermath, he presented a time line of what hospitals should do in similar circumstances. He emphasized that the recommendations were his thoughts exclusively and not offered on behalf of any government agency.

Immediate Steps

The first thing a hospital has to deal with is a leadership crisis, according to Dr. Rosenstein. It should pick a point person to take charge of everything that follows.

Because he was out of the building when the suicide occurred at the Hatfield Center, Dr. Maryland Pao, a deputy director, assumed that role.

The point person should call a brief meeting to assess what needs to be done first and to delegate responsibilities, Dr. Rosenstein said.

Priorities include making sure that the immediate needs of the other patients are met and that such physical dangers--as open windows--are taken care of.

The family must be notified, he said, and clergy--if appropriate. A staff member should be designated as liaison for the family to help with the questions they are sure to have.

Hospital administrators and police must be called immediately. It is also important to note that the area in which the patient died is a crime scene, Dr. Rosenstein warned. Given that, the scene cannot be cleared until the police complete their investigation.

A final note should be put in the patient's medical record, he added, and then the chart should be sequestered: "There should not be any revision."

Soon After the Event

During the first few days, clinicians should attend to the emotional needs of patients and staff, Dr. …

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