I continually hear that psychiatric hospitals don't need to implement design features to reduce the risk of suicide in patient rooms and patient toilets because they utilize 15-minute checks on patients that are suicidal.
This logic is wrong for at least three important reasons:
- It only takes four or five minutes of adequate pressure on the carotid arteries in a person's neck to produce death or irreversible brain damage by oxygen deprivation to the brain.
- Studies show that there are 500 inpatient suicides per year in the United States by patients who are on 15-minute checks. That is an average of more than successful suicide one per day.
- Suicide assessment tools now available are not dependable.
Let’s examine each of these separately:
- A Study by The Joint Commission in 2000 showed that patients tying objects tightly around their necks can stop the flow of blood to the brain which can result in a lack of oxygen to the brain and will cause death or irreversible brain damage in only four or five minutes. This is known as Anoxia. Patients on 15-minute checks have been known to observe the pattern and frequency of the checks so they can time their action to allow plenty of time to accomplish their goal of successfully committing suicide.
- A study by the American Psychiatric Association in 2003 found that there were 1,500 successful suicides on inpatient units annually (that averages over 4 per day) and that one third of those patients (average of 1.33 per day) were on 15-minute checks. While 15 minute checks may help prevent some suicides, they are still letting 4 patients commit suicide every three days.
- The same study shows that two-thirds of the inpatients that successfully committed suicide were not in 15-minute checks, presumably because the staff had not identified them as a suicide risk. This is in no way an indictment of the staff. Many patients now have had multiple hospitalizations and have become very good at knowing exactly what to say and how to act to be placed on a level of responsibility that will give them access to their method of choice. Studies conducted in 2001 and 2006 that were published by the American Psychiatric Association and the Academy of Psychiatric Law concluded that hospitals and architects should proceed as if there is no reliable means to determine a patient’s true intentions.
Therefore, relying on 15-minute checks of patients that are determined by staff to be suicidal is ignoring the true cause of death in many inpatient suicides and placing a lot of faith in the suicide assessment tools that are currently available and have proven to be unreliable. The physical environment into which we place all of our patients should remove or reduce the inherent risks for suicide to the extent possible.
Let the building do what the building can so the staff can be relieved of concerns about inherent hazards in the environment and they can concentrate on treatment which only staff can provide.