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About Mental Health

When patients are discharged from hospitals, it usually means they’ve recovered sufficiently to resume their daily lives. But that’s not the case for patients released from psychiatric facilities. According to a new meta-analysis in JAMA Psychiatry:

The suicide rate for former psychiatric inpatients is 44 times higher than that of the general population — regardless of country.

The risk is highest in the three months following discharge, when it’s approximately 100 times that of the general population. Scientists have been studying this phenomenon since the 1950s, but there’s been a greater focus on the issue since the U.S. suicide rate began climbing in 1999, from 10.5 deaths per 100,000 to 13.3 deaths per 100,000 in 2015. Globally, suicide is second only to road accident injuries as the leading cause of death among young adults.

The authors of the meta-analysis reviewed 100 studies published on five continents from 1946 to mid-2016. One key finding: Suicide risk remains elevated for years after discharge. Patients who had been out of psychiatric hospitals for as long as 10 years still had a suicide rate 25 to 30 times that of the general population. “Everyone knew it was high, but people didn’t know that it was this high,” says Christopher Ryan, an Australian psychiatrist and professor at the University of Sydney, who was one of the meta-analysis’ authors.

The post-hospitalization risk appears to have increased in the past two decades. Studies between 1995 and 2016 show a higher overall rate of suicide risk for former patients compared with earlier studies. Psychiatrists and other mental health care providers have made numerous efforts, such as redesigning the mental health care system to include more community-based care options, “to improve this rate over the years, and everyone would have liked to have seen a decrease,” Ryan says.

Since a majority of patients admitted to psychiatric hospitals show signs of harming themselves, some experts say it’s logical to expect those patients to remain at a higher risk of killing themselves after they are discharged. But that assumes psych wards are not helping inpatients with suicidal tendencies. Ryan has an even more damning theory: “It’s a distinct possibility that a percentage of those deaths are caused by the hospitalization itself.” He suggests that some patients, especially ones who have been hospitalized against their wishes, wouldn’t have killed themselves if they hadn’t been institutionalized in the first place. That said, Ryan is quick to add that psychiatric institutionalization has proved to be beneficial, even lifesaving, in a majority of cases.

While the trends paint a grim picture, Ryan cautions that some of the rates might be inflated since the meta-analysis combines several studies carried out under different circumstances.

What’s the best way forward? Mark Olfson, a professor of psychiatry at Columbia University Medical Center, who wrote an editorial for JAMA Psychiatry about the meta-analysis, says more support needs to be provided to former patients during the high-risk period. He suggests one low-cost option: “mobile health technologies with text messaging functions,” which could help smooth the transition from hospital to home, facilitating frequent patient monitoring and opportunities for earlier intervention during emerging suicidal crises. In a 2014 paper published in the journal BMC Psychiatry, European researchers found that this type of monitoring tool “can be used shortly after discharge from medical care centers in the prevention of high-risk post-acute suicide.” It might just take a text to save a life.

  • Sushmita Pathak, OZY AuthorContact Sushmita Patha

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