Inpatient suicides in an Australian mental hospital.

OBJECTIVE: Suicide rates among psychiatric inpatients are higher than in the general population. Mental health professionals are poor at predicting suicide risk.
METHOD: One hundred and three inpatient suicides, over a 21-year period, in a large psychiatric hospital in Melbourne were examined. The characteristics, including demographic and clinical data, for 60 of these suicides were compared with a matched comparison group stratified for the time of admission. Violent methods (including jumping in front of trains, trams and road traffic, jumping off buildings, hanging and drowning) were most frequently used.
RESULTS: Over one-third of the suicides occurred during periods of approved leave and a similar number occurred after absconding from the hospital. Suicide was associated with a diagnosis of schizophrenia, increased duration of admission, more frequent prescription of neuroleptics and antidepressants, previous deliberate self-harm, suicidal ideation at the time of admission and during the admission, suicide attempts during the admission, unstable (fluctuating) suicidal ideation during the admission and a greater number of ward transfers.
CONCLUSIONS: Psychiatric units should be developed away from readily available methods of suicide. Patients with previous or intra-admission suicidal ideation or attempts, or unstable suicidal ideation, should be carefully observed to avoid absconding. Suicide risk should be carefully evaluated in such patients prior to approving periods of leave.