Screening and Prevention of Suicide Risk in Hospital.

Korean J Leg Med. 1999 May;23(1):105-118. Korean.

Suicide rates are higher in the psychiatric patients than at any other hospitalized patient groups. Common factors of failures in suicide intervention/prevention during psychiatric hospitalization treatment are inadequate diagnostic psychiatric representation in overall treatment of patients and lack of objective standardized behavior assessment methods. Major lethal suicide behavior components observed from case studies include (1) erroneous diagnosis by primary and secondary care clinicians (2) inadequate or inappropriate selection of treatment methods (3) incompetent observation and supervision of admitted patient to prevent self-harm (4) superficial care and conflicting support given by nursing staffs (5) negligence of informed consent (6) lack of precautionary environment and surroundings (7) unlawful hospital admittance procedures (8) neglecting of moving hospital department for better care. Most of the case studies from Korea indicate that the judgments are against primary psychiatric clinicians for full responsibility of damage, negligence and wrong doings. In Japan, however, there are various decision and verdicts are made for or against the clinicians. There are very few cases where judgments are against clinicians to take responsibilities for the suicidal behavior. These decisions indicate greater recognition and acceptance of expert diagnostic and decision making authority given to primaryter, psychiatric physicians. This is based on a belief and acceptance of court that establishing therapeutic relationship between patient and clinician is an essential factor in nursing care of suicidal patients. There still lacks firm legal frameworks for handling reported suicides from hospitalized psychiatric patients. Misconceptions about suicide, lack of appropriate suicide risk assessment, inadequate identification of standardized suicide risk factors and danger signs all attribute to the delay in any legal discussion or stipulation of legal foundation for handling suicide committed among admitted patients including contractual responsibility. Even when a contract can be completed between the participating parties, details of agreement are still . remain in question, i.e.; focus on intervention and prevention of suicide or facilitate reintroduction to the community. Disharmonious treatment of patients will either destroy humane treatment of the patient. Protecting patients from the dangers of suicide will need collaborative team work among legal, academic, medical sectors. Suicide prevention is everyone s responsibility.