Almost any article of clothing and any protruding object can be utilized for self-asphyxiation.” 5(p663)Ĭommon areas for concern on psychiatric inpatient units are ligature attachment points that pose a hanging risk from a sitting or kneeling position. 15-minute suicide watches tend to allow a patient sufficient time to commit suicide, especially if the patient has a private bathroom with a lockable door.
4(p64) However, “It only takes 4 or 5 minutes of adequate pressure on the carotid arteries in a person’s neck to produce death by oxygen deprivation to the brain. The patient’s bathroom is the one area where a patient can be assured of some privacy for a certain amount of time. In psychiatric hospitals, the most frequent method of suicide is hanging, and 75% of inpatient suicides occur in the patient’s bathroom, bedroom, or closet. Risk was not adequately assessed in about 60% of suicides, or else the risk level was not accorded appropriate precautions. According to JCAHO, the greatest clinical root cause of inpatient suicide is a failure in clinical assessment. Inpatient suicide is the most common sentinel event reported to the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) over a 10-year period (1995 to 2005).
Courts and juries generally perceive inpatient units as having a greater degree of control over the patient and, thus, a greater responsibility to prevent suicides.
While approximately 1 of 4 outpatient suicides will result in a claim, about 1 of 2 inpatient suicides will result in a claim. 1 It is estimated that a psychiatric nurse will experience a completed suicide every 2½ years on average. Of the 35,000 or more suicides per year in the United States, about 1800 (6%) are inpatient suicides.
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