Lack of continuity — a problem in the care of young suicides

Abstract

The course of the psychiatric in-patient treatment received by 34 young people aged 15-24 years before their deaths from suicide was studied retrospectively on the basis of medical records. The quality of the care that they were given was appraised in terms of continuity, an important aspect of the care of young individuals during a period of dynamic development. There were two suicides among patients in child psychiatric care and 32 suicides among those in adult psychiatric care. Continuity of child psychiatric care was satisfactory, while the striking discontinuity in adult psychiatric care, in terms of contacts with doctors, therapists and other staff, with from 3 to 30 different doctors being involved during the period of care, may have been a factor contributing to the suicidal outcome in these cases. In total, 20 of the 34 young people had reported previously known suicide attempts, and notes concerning suicidal communication were mentioned in all but three of the records, while in only three of the records had any form of suicide-risk assessment been noted at the last care session before the suicide. Information about the suicidal process was thus available for most of these records but, as a rule, suicidal analyses were nevertheless lacking.

The violence relapse process – a qualitative analysis of high-risk situations and risk communication in mentally disordered offenders

“…Within this domain, several authors have studied risk communication of suicidal intent to improve the detection and hence prevention of suicide (e.g. Å sgård 1990, Gould & Kramer 2001;Hultén & Wasserman 1998;Runeson, Beskow, & Waern 1996). These researchers have developed techniques to reconstruct the process leading to suicide attempts and to identify related risk communication (Brent, Perper, Kolko, & Zelenak 1988).…”

“…These researchers have developed techniques to reconstruct the process leading to suicide attempts and to identify related risk communication (Brent, Perper, Kolko, & Zelenak 1988). Suicidal communication has been divided into two major categories Á/ verbal (direct and indirect) and non-verbal (direct and indirect) communication (Hultén & Wasserman 1998;Wolk-Wasserman 1986). Defining communication according to these terms, researchers have found that almost all of the informants in these studies had communicated, in one way or other, suicidality (Å sgård 1990;Hultén & Wasserman 1998).…”

“…Suicidal communication has been divided into two major categories Á/ verbal (direct and indirect) and non-verbal (direct and indirect) communication (Hultén & Wasserman 1998;Wolk-Wasserman 1986). Defining communication according to these terms, researchers have found that almost all of the informants in these studies had communicated, in one way or other, suicidality (Å sgård 1990;Hultén & Wasserman 1998). One important conclusion was that suicidal communication could appear in virtually any form and, therefore, the interpretation of the communication is a matter of educational level and awareness of the practitioner (Å sgård 1990).…”

Recommended care for young people (15–19 years) after suicide attempts in certain European countries

“…A recent Swedish study (11) has shown how treatment and care for young people before completed suicides were characterised by a lack of continuity in terms of the medical team involved and the treatment applied.…”

A global view of suicidal behaviour

“…It is doubtful whether the influence of the media could be considered responsible for more than 1–2% of suicides 23 . Considering the lost opportunities for intervention elsewhere, for example in the treatment of mental illness in the suicidal, 24–26 it is more important to focus on important clinical issues, rather than scapegoating the media 23…”