Standards for emergency short-term hospitalization vary from state to state, so familiarize yourself with your state’s standards. Although one standard for involuntary admission is often imminent threat of harm to self, do not base the threat of danger only on a patient’s self-report. One study of patients who committed suicide while hospitalized found that 78% denied suicidal thoughts at their last communication.9 However, “locking up” suicidal patients to prevent a malpractice suit is equally inappropriate.
Assess suicide risk during a thoroughly documented psychiatric examination with particular attention to the patient’s history of suicidal behavior. Record details of the assessment in the patient’s chart (Table) at the time of evaluation, and document how these clinical factors influence your final decision.
Involuntary hospitalization provides the immediate benefit of supervision in a safe environment, and patients can gain short-term therapeutic benefits from inpatient treatment whether or not the admission was voluntary.10 Patients may eventually recognize admission was helpful, but their attitudes about the process often do not become more positive. To ease the stress of involuntary admission:
- acknowledge the patient’s disapproval
- tell the patient why he’s being hospitalized
- inform the patient about his or her legal rights.
Table
Documenting suicide risk assessment
| Include in patient’s chart… | Examples… |
|---|---|
| Short-term factors | Current suicidal ideation/plan, lethality potential, current stressors (bereavement, illness, loss of job), recent discharge from a psychiatric facility, time of year (holiday effect, anniversaries) |
| Long-term factors | History of suicidal behavior/attempts, personality factors (agitation, hopelessness), gender, age, marital status, substance abuse history, psychiatric illness (depression, bipolar disorder, schizophrenia) |
| Appropriate psychiatric interventions based on the assessed degree of risk | Involuntary admission, intensive monitoring, outpatient visits, home healthcare nursing, residential placement, substance abuse treatment |
| Sources of information used | Medical records, patient self-report, family report, observation |