Managing Suicidal Inpatients
The suicidal patient is the most common and the vexing clinical challenge for the staff on an inpatient unit. First, clinicians’ capacity to predict suicide is woefully limited (Goldstein, Black, Nasrallah, & Winokur, 1991). Second, not all that appears to be suicidal behavior is truly the pursuit of a deadly outcome. Third, even when clinicians know a patient is truly suicidal, they cannot ensure a sanguine outcome, because of the limits of the security measures and therapeutic tools at their disposal and, in some instances, the sheer determination to die on the part of the patient. In fact, as many as 5% of deaths by suicide in the United States annually have occurred on psychiatric inpatient units (Crammer, 1984). Finally, work with the suicidal patient may evoke intense and irrational feelings in the clinician, not the least of which are fear of failure and consequent humiliation or litigation. It is no surprise, therefore, that many clinicians find work with suicidal patients disturbing or aversive.