Suicide in hospital: guidelines for prevention.

Few events in medical practice create such a sense of failure and guilt as the suicide of a hospital inpatient. The mortality rate is known to be increased in severe psychiatric illness just as it is in most other medical illnesses. The analogy, however, is not generally accepted. Death in cardiovascular or malignant disease, for example, is regarded in many cases as inevitable, a welcome relief from months of pain and suffering. Suicide, by contrast, is considered an unnatural event, one which is avoidable and preventable. In each case of suicide there is a belief among medical and nursing staff that they should have done better: they should have assessed the patient more carefully; been more aware of hints of suicide; provided closer supervision; or not agreed to the final period of leave.