Contacts of suicidal alcohol and drug abuse patients and their significant others with public care institutions before the suicide attempt.

Interviews were conducted with 19 alcohol and drug abuse patients, consecutively admitted to an intensive care unit owing to attempted suicide by intoxication, with their 33 significant others and with care personnel, concerning the patients' contacts with psychiatric, somatic and social care institutions before the suicide attempt. All the patients contacted public care institutions between 1 and 6 months before the suicide attempt in question and 12 patients between 1 and 7 days before. Fifteen patients had contact with psychiatric institutions. The personnel not infrequently failed to explore the incidence of suicidal thoughts. Major difficulties were also encountered in securing patients' co-operation in the treatment when suicidal risk was judged to be present. Fifteen patients had contact with somatic institutions. The suicidal risks were seldom detected, because they were thought to be connected with depression, which was masked and therefore often overlooked. Twelve patients had contact with social institutions, the personnel of which generally avoided discussing the patients' suicidal problems. Significant others sought help for 12 out of the 17 patients, but contacts were usually fruitless. The reasons for treatment difficulties are discussed, with reference to the patients' individual problems such as their poor self-esteem and pronounced needs to compensate for it, and the personnel's difficulties in tackling the patients' compensatory defences and dependency needs.