A new study published this week in JAMA Psychiatry indicates that patients are at an increased risk for suicide during the three months immediately following discharge from an inpatient psychiatric hospital. According to the results, patients who were not matched with ongoing outpatient care were at a higher short-term risk for suicide.
The authors, led by Mark Olfson, a professor of psychiatry at Columbia University, found that patients who were discharged after being treated primarily for issues related to a psychiatric diagnosis were 15 times more likely to commit suicide than similarly matched patients who were treated for non-mental health issues.
Past research has demonstrated that patients diagnosed with mental health disorders are at an increased risk for suicide immediately following hospitalization. In 2014, for instance, Danish researchers finding that suicide risk increased dramatically following hospitalization raised “the disturbing possibility that psychiatric care might, at least in part, cause suicide,” although the authors did not uncover clear explanations for their findings.
In this most recent study, Olfson and his colleagues attempt to examine how the increased suicide risk following hospitalization connects with different diagnoses and the extent of outpatient support received. To do this, the researchers examined data on Medicaid patients between 18 and 64 who were discharged from a hospital and had a first-listed diagnosis of depressive disorder, bipolar disorder, schizophrenia, or substance use disorder. The results of these patients were compared with a random sample of hospital patients who did not have any diagnoses associated with mental health issues.
After examining the data on almost two million patients, the researchers found that suicide rates after hospitalization were significantly higher for those being treated for mental health issues than those treated for non-mental issues. Breaking it down further, those diagnosed with depressive disorders were found to be at the highest risk (235 per 100,000 person-years) compared to those diagnosed with bipolar disorders (216 per 100,000), schizophrenia (168 per 100,000), substance-use disorders (116 per 100,000), and other mental disorders (160 per 100,000). These numbers are compared to those who were not diagnosed with any mental health issues (14 per 100,000).
Those without any outpatient mental health care in the six months leading up to hospitalization were found to be at a heightened risk (1.7 times) for suicide. In an interview with Medpage, Olfson points out that it is not uncommon for patients to be without outpatient mental health care following hospitalization, noting that only about half receive outpatient care within the first week and one third still do not receive outpatient care within the first month.
The authors conclude:
“These patterns suggest that complex psychopathologic diagnoses with prominent depressive features, especially among adults who are not strongly tied into a system of care, may pose a particularly high risk. As with many studies of completed suicide, however, the low absolute risk for suicide limits the predictive power of models based on clinical variables. These constraints highlight the critical challenge of predicting suicide among recently discharged inpatients based on readily discernible clinical characteristics.”
Hear an interview with lead author Dr. Mark Olfson about this study here →
Olfson, M., Wall, M., Wang, S., Crystal, S., Liu, S.M., Gerhard, T. and Blanco, C., 2016. Short-term suicide risk after psychiatric hospital discharge. JAMA psychiatry. (Abstract)
Very Worthwhile Article.
Suicide risk following hospitalization seems to be a well established pattern. Suicide within hospital is a lot more difficult to complete, so if a person is on drugs that are causing agitation then they are a lot more likely to attempt suicide when they leave.
Suicide risk is supposed to be greatest when a person newly goes on drugs or changes drugs or comes off drugs – and this happens in hospital. So if the patient leaves hospital but is not stabilised then they are at risk.
Suicide is very high among people diagnosed with Serious Mental Illness and there have been lots of studies conducted into why this is. In my own case, it was the psychiatric drugs and akathesia.
I agree, Fiachra, the psychiatric drugs do make people very sick. But I’d like to add that the absolutely appalling maltreatment people receive in hospitals when they are diagnosed with a “mental health issue” could be part of why so many try to kill themselves afterwards, too.
I was “snowed” with willy nilly, ever changing drug cocktails for ten days, eight or nine different drugs each day, these made me so whacked out of my mind that I really can’t remember most of those first ten days of my forced hospitalization. Except, the hospital would not let me speak to my family, would not let my family come visit me, and they shipped my friends who came to visit me away, too. My phone and all my possessions were taken away, this doesn’t happen in other types of hospitalizations. The psychiatrist only spoke to me for about 5 minutes in the beginning, five minutes after the ten days of “snowing,” then she did spend a bit more time with me at discharge, since she was pissed she couldn’t convince my insurance company to pay for me to be hospitalized forever.
Of course, this psychiatrist’s partner in crime was later arrested by the FBI for having lots and lots of patients medically unnecessarily shipped long distances to himself, having his psychiatrist partners in crime “snow” patients in the hopes of preventing the the patients from breathing, so he could perform unneeded tracheotomies on these patients, for profit.
But I dealt with the deplorable Kuchipudi back when he was committing this fraud at the ELCA Advocate Good Samaritan hospital, prior to his move to Sacred Heart.
I also had an antique gold bracelet switched out for a cheap fake gold copy while I was tortured at that hospital, approximately a $7000 theft. Perhaps the medical community would prevent so many suicides by those dealing with “mental health care,” if they learned to treat those dealing with “mental health care” in a respectable and legal manner, instead of having the doctors behave like psychopathic criminals?
In my case, being detained, totally stripped of my rights, forced to take drugs that made me feel like hell AND hallucinate AND plunge into psychosis (for the first time in my life), and then told I’d have to keep taking them for the rest of my life and that I could never hope to recover was more than a little traumatic.
At no stage was I violent or abusive…my response was freeze and/or flight rather than fight.
They told me that they could come to my home and lock me up again when ever they felt like it, which left me nowhere to feel safe. I own my home and it has always been my safest space. They threatened to invade it as they had invaded my mind and body.
It was abuse piled on top of abuse with no hope of reprieve, and it was called psychiatric “care”!
Then, after I got out, my shrink said I could stop taking the meds (Zyprexa and Avanza) if I didn’t like them (no suggestion of a taper and no warning of what would happen if I did stop), and said I had to go back to work even though I was still hallucinating and feeling terrified. And it was the workplace that had caused my breakdown in the first place.
No prizes for guessing what happened next. Thankfully, I didn’t succeed….obviously….but was put back on the drugs and it took me 4 years to finally get off them. That was 6 years ago and the more I read, the more I realize I still have residual symptoms that weren’t there before.
Psychiatric “care” is cruel torture and those who practice it need to be locked up and put on the same “medications” (quantities, combinations etc) that they have inflicted on their “patients”, before being released to fend for themselves.
I suspect we’d have fewer psychiatrists if that occurred as such treatment really does make one feel very suicidal indeed.
Of course suicide rates increase after the abusive lockup “hospitalization”, that’s when many people discover what “help” really means.
I am feeling suicidal let me go get some “help” a strip search, my phone confiscated and locked up and told I can’t smoke and do nasty nicotine withdrawals for unknown period of detention wile being forced or coerced with threats needles violence to take dangerous disabling drugs walk around all shuffle drool Haldol.
But we will give you a nicotine patch… Every smoker knows the little trickle from those things doesn’t work you need the quick rise from smoking for relief.
The lack of outpatient care has alot to do with people avoiding any place and anyone who might inflict inpatient “care” again.
Anyone who has ever endured inpatient knows the question “do you feel like hurting yourself” in reality means do you want more lockup coerced drugging strip searches and abuse ?
Also I would imagine that if things changed and hospitalization was really pleasant they would have a huge problem with people faking that they are suicidal when they are just a little lonely and depressed.
Your description so much like being admitted to a prison that it boggles the mind. Only a cold-blooded sociopath–no scratch that–only a really stupid sadist…oh, never mind. I was trying to think of the kind of doctor who would believe that that kind of treatment is good for anyone. I don’t think they do think that. It’s good for them if patients keep coming in and public and private insurance companies keep transferring funds. A racket, in other words.
No surprise here!
Anyone who has been treated in the last two decades at most any psych unit and those who were treated in the many many poorly run state institutions will be able as some of the commenters already have -multiple examples of why one would like not to be after hospital treatment.
My favorite is the psych unit nurse who called me a psycho bipolar bitch
A label that I will hold forever in my memory.
If I had a legal expert to use I certainly would try to sue for the breaking of the HIPPA act and the
some of the doctors I encountered in that hospital on malpractice issues.
Some docs have no idea of the difference between acting out and psychosis.
Others come from a different culture and have not taken the time to inform themselves of the nuances of American culture to the great detriment of many of their patients.
Maybe if any adder mentions Woody Guthrie you might want to ask or even google his name especially now that a Woody Guthrie fan is a Nobel Laurette.
I haven’t read the interview not prepared for any triggers now but I will
Sometimes I find it amazing what connections remain invisible or are actively ignored in our world.
What about the even higher risk of homicide and suicide among people who are not hospitalized because of your efforts to, at worst, pretend a brain disease doesn’t exist, or, at best, to pretend there are alternative treatments available besides the mainstream? Prison? Yeah, that’s real compassionate and enlightened medicine.
What about people who suffer from deeply violent and vengeful delusions against family, friends, neighbors, and strangers, that have no basis in reality whatsoever? Delusions that result in familial abuse? This community doesn’t care about these victims any more than mainstream psychiatry does. You’re all phonies.
I am sorry for your pain.I am sorry for all of our pain.
By coming here you entered into a doorway.
It is discumbulating at first but like a 12 step program if you read 90 stories you will find one that hits home for you.
I think many here would not deny that folks have altered states but in what to do and how to treat them.
Many folks are caught in side effect or withdrawal hell
Many are caught in past or present trauma hell
There still is no good information that solidly explains why one persons altered state is benign while another persons isdangerous to themselves or others
We all are learning so Ihope you can stay and take a few breaths and read those 90 stories.
In my opinion the only way to Recover is to reject the disease model and move to a non disease model.
As regards unjustified grievances these tend to be very common in the normal population. Just look at how politicians tune in to this tendency.
One more thought.
Has anyone including those in the field of disability studies done a careful study of when and where mental illness became a entertainment horror cum sideshow/freak show commodity?
This seems to be part and parcel along with so many other issues.
Splendor in the Grass versus Halloween
A Child is Waiting versus
Fringe or X Files
Very white but still lethal
Ivan remember watching The zElephant Man the movie was was horrified David Lynch I think took the horror film shooting and delay of his being seen on camera as anon protested explicit directorial tactic
I had no issues with the play
or many plays that delved deep into madness like Equas or even Man of La Mancha or de Sade
there was some sort of honor that surrounded the story even if it contained horrors
Just a thought
And BTW who is funding this type of art?
Justin, thanks for posting this. I think this is self-evident, actually. Treatment is mostly abusive. Yet when we leave, and damn our treators, or try to sue, the surrounding communities are not helpful, nor are most of our friends and families, and certainly most of us can’t even get legal recourse. So no wonder people kill themselves!
Oh, if you can find a friend who supports you and who understands how horrible it was, you probably are much better off. Same with the exceptional therapist who might be supportive and recognize the trauma effect. Otherwise, you’re pretty much fucked over.
I got kicked out of my church, shamed in my community, my family didn’t support me, I lost almost all my friends AGAIN, and certainly the System told me I was making it up or “paranoid.” I was threatened and attempted force drugged. Hey, facts are facts. Abuse is abuse, it’s not a matter of “not liking it,” It was ABUSE. And no recourse, no way to sue, and no damn apology. They were not “just doing their job.” They were cruel, deliberately harmful, and I am not backing down on that one.