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Abstract
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It was 2 a.m. as I tossed and turned on my firm call-room mattress, anticipating the next time the pager would buzz me fully awake. A few floors above, a patient was making vivid suicidal statements to his nurse on the medical unit. In accordance with hospital policy, he had earned himself a bedside sitter, loss of phone privileges, and an emergency psychiatric consultation with me, the overnight resident. "Of course I'm not going to kill myself. If I was going to, do you really think I would have said that?" he asked me incredulously. "I was angry, in pain, and couldn't sleep. Can I just get my phone back?"
The next week, I admitted a patient to the psychiatric unit. She had disclosed suicidal thoughts to her therapist, her sister, and the doctor in the emergency department. She had even shared her idea to use the pills her mother kept in the bathroom vanity. I asked her, "What stopped you from going through with it?" Her response rang in my ears, in tune with the remarks from the angry man from the week prior: "I don't actually want to kill myself. If I truly did, I'd never have told anyone." The more patients I encounter in training, the more frequently I hear echoes of this sentiment. Surely, patients who actively seek care and candidly share their suicidal thoughts are at reduced risk because of their openness and help-seeking natures. However, what about the subset of patients who have suicidal thoughts but do not reveal them? Or those who never receive care at all? Even on my soft mattress at home with my pager turned off, these are the patients who keep me up at night.
Perhaps the central question I have been wrestling with is whether most people who commit suicide actually seek help and disclose their suicidal thoughts. As part of the suicide prevention efforts within our institution, we obtained data from the Connecticut Office of the Chief Medical Examiner. Over the span of 15 months, these data represented 512 lives lost statewide, and we were able to match many of these individuals to our hospital's electronic health records. We then surveyed the charts of these patients to learn what we could from their health encounters in the year preceding their deaths. Two alarming numbers emerged: nearly 70% of these patients had not interacted with a mental health professional, and only 15% had ever been identified as suicidal--and not because of lack of screening...
Language: en |