On December 3, there was a front page story in the Houston Chronicle titled "Family looks for answers after son's suicide at the Menninger Clinic." The Menninger Clinic had moved to Houston from Topeka, Kan., some years back and became part of the Department of Psychiatry at Baylor College of Medicine, where I previously worked. It had a sterling reputation of treating complex and well-to-do patients with longer than usual hospitalizations.
However, the newspaper story discussed several—arguably, preventable—patient suicides in recent years at the facility. If the renowned Menninger Clinic has had such suicides, what about the rest of us? This time of year may behoove us to pay special attention to the suicide risk of our patients.
As it turns out, the risk seems to be reduced from Christmas Day to New Year's Day, perhaps attributed to the hopeful nature of the Christmas holiday. Yet, there are always ways to reduce the rate of suicide for the highest risk patients.
One of the unexpected pioneers in preventing suicide was developed early in this decade by Magellan, the for-profit company that shifted from the psychiatric hospital business into managed care. Magellan Complete Care of Arizona wanted to create a best-practice, zero-suicide system, just like airlines try to do with plane crashes. They developed continuing education and professional development. A brief screening questionnaire for outpatients found an unrecognized suicide risk of 5% to 10% in established patients.
Though smaller, the Henry Ford Center in Detroit reported doing even better with no suicides over two years. They emphasized the importance of the therapeutic alliance, which included negotiating the removal of guns and/or ammunition at home. Given that most suicides have a short window of strong desire, any interference may get the person past the time of highest risk.
In recent years, other high profile suicides, including that of Robin Williams, have brought periodic increased attention to preventing suicide.
Recommendations include the following:
1. Talk, talk and keep talking about suicide, whether with public education about the risk or in interactions with patients.
2. Screen for depression and suicide risk, especially for associated anxiety.
3. Don't be lulled into a false sense of security when patients at high suicide risk seem to improve for no sound clinical reason, such as “Christmas cheer.”
4. Take care not to increase suicide risk in clinical decision-making, such as by prescribing antidepressants to someone who might be bipolar.
5. Recognize that clinical depression can be a terminal illness in the sense that suicide is not a rare outcome.
6. Work to reduce the stigma of mental illness.
7. Advocate for more mental healthcare resources, especially with a new government administration coming.
8. Advocate for gun control, as guns are the most lethal suicide method.
9. Appreciate when suicide may be considered to be a rational and normal response, such as in so-called physician-assisted suicide.
10. Don’t use the term “suicide” when the primary motivation is something else, as in so-called terrorist “suicide bombers.”
Perhaps you have other preventive ideas that work. Please share them in the space below.