We often feel relief when someone we care about is admitted to psychiatric hospital at a time when they are at risk of suicide. We assume that they are safe there.
This is not always the case, and sometimes patients do die by suicide while they are inpatients in psychiatric units. These are catastrophic events. Such deaths devastate families and are almost always avoidable.
I run a Suicide Crisis Centre in Gloucestershire and some of the clients who come to us need (and often want) psychiatric admission. There are times when we help to facilitate that. We used to feel that they would be safe in hospital but now we know there can still be significant risks and so we keep in contact and visit them, and offer ongoing support. There have been occasions when clients of ours have attempted suicide or self-harmed during an inpatient stay. These have occurred in a psychiatric hospital which is spoken of highly by many patients. I have been a patient there myself in the recent past and know that there are dedicated staff on the wards who work very hard to ensure the safety and wellbeing of everyone under their care.
The correct levels of observation within psychiatric units are vital, though, and this is one area where I have real concerns. I was admitted to psychiatric hospital earlier this year during a depressive episode. I have bipolar disorder. As I was assessed as being at high risk of suicide, I was placed on 15-minute observations.
These 15-minute observations continued throughout each day, but after 9.30pm each night they reduced to only hourly observations. There were few staff on duty at night, so I assume there are not enough staff to observe high risk patients more frequently. This is extremely concerning in terms of safety. I was no less at risk of a suicide attempt after 9.30pm. In many ways, a person may be more at risk because mood may dip further as darkness falls.
Our clients report that this still occurs. Patients on 15-minute watch during the day are only being checked hourly at night.
Within our local psychiatric hospital, most of the wards are unlocked. This has many advantages as it can feel less restrictive and contained. However, the levels of observation need to be very high to prevent patients from absconding or from harming themselves within the hospital.
I was sectioned a few days after being admitted and found that being sectioned replicated aspects of my own past trauma. During traumatic events we may be rendered powerless and in some cases we are physically trapped and controlled. Sectioning can feel very similar to that and can be re-traumatising for some patients. As a result, my distress was acute and my suicide risk rocketed. It felt to me that the only way to be released from this inner torment was to end my life or escape from hospital. Staff seemed not to hear me when I spoke of feeling in torment. They replied by saying that they realised that sectioning was "frustrating". This meant they didn't see the increased risks. They didn't recognise that I was having a very extreme reaction to being sectioned and they assumed I was simply feeling a general sense of frustration at being contained.
A couple of days later I was presented with an opportunity to escape. I was in the communal area close to the door. There had been a staff member monitoring activity in that area but he went into the kitchen. I walked off the ward and left the hospital. This led to the police being alerted, because a patient under section who was considered at high risk of suicide was now at risk out in the community.
I spent 12 hours away from the hospital. The risk of suicide during that time to a vulnerable patient is evident.
As well as the clear failings in the levels of observation here, the risk of absconding could have been greatly reduced if my high levels of distress had been addressed by staff. If staff ensure that they get to know each patient well and understand that they are individuals with differing responses and needs, and look at how to best support each individual, that may also help to reduce the number of patients who abscond or who harm themselves within the hospital.
My experience shows that staff need to monitor communal areas at all times and pay close attention to exit doors. They can ensure that patients who are identified as high risk of self-harm or absconding are kept in "line of sight" when in communal areas. This means that a different member of staff will be responsible for keeping each "at risk" patient in their sight at all times.
Accurate assessment of risk is important to ensure that those at highest risk have the correct level of observation. After my escape I was assessed as being at very high risk of suicide and placed under constant supervision, which means that you have a member of staff with you at all times. However this was put in place a little too late since I had already absconded and been at high risk in the community.
I am an ardent supporter of psychiatric hospitals and believe that we urgently need more inpatient beds. When adequately staffed and well run, they can be one of the most powerful and effective ways to prevent suicides. But there are clearly incidents of inadequate supervision and observation in some hospitals, and sometimes a lack of correct risk assessment or lack of knowledge or understanding of the patient. The consequences of this can be catastrophic.
For information about the Suicide Crisis Centre:-
The Suicide Crisis Centre only operates in Gloucestershire but there are details on the website of national organisations which support people at risk of suicide.
If you have been bereaved by suicide: http://www.uk-sobs.org.uk