This statement appears in a 2009 article: "It is estimated that 4%-7% of the 32000 suicides in the US each year occur in inpatient psychiatric settings." That works out to be an estimated 1280-2240 suicides yearly in US psychiatric hospitals. More recently (2012) another article notes: "Of the 35000 or more suicides in the US, about 1800 (6%) are inpatient suicides." So for 2010, when there were 38364 suicides in the US (CDC), these estimates suggest that 1534, 2301, or maybe 2685 suicides took place in psychiatric hospitals in the US.
The Joint Commission (TJC), the body that accredits all US hospitals, including psychiatric facilities, tracks "sentinel events" in inpatient settings. These are "an unexpected occurrence causing death." Suicides are sentinel events. Per the TJC suicides in all hospitals (and within 72 hours of discharge), both medical and psychiatric, numbered 131 in 2011 and 85 in 2012. These figures are likely less than one-half of one percent of all US suicides for those two years. The TJC reports that from January 2004 to June 2013 there were 710 suicides in all US hospitals.
Per TJC, all inpatient suicides in all US hospitals for more than 12 years don't come close to estimates that are cited and recycled in articles in refereed journals. Moreover given that most of these hospital-related suicides probably took place after the victim left the hospital the actual number of inpatient suicides in the US is relatively small and the number attributable to psychiatric hospitals is far smaller also. This conclusion is supported by a survey of inpatient suicides (Ballard et al., 2008) that reported only 500 inpatient suicides in the US between January 1995 and June 2006.
We suspect that the problem with the prevailing estimates is that they are obsolete and may have originated in the state hospital era where tens of thousands of high risk individuals resided on state-run campuses. Even a low number of suicides in hundreds of state institutions, many with 3000 or more patients, would likely amount to a share of US suicides equal to the estimates. As many state hospitals patients had grounds privileges and some could even go home on leave, the opportunity for suicide was far greater than in contemporary psychiatric facilities. Elopements were common and were motivated by suicidal intent in some cases. Nonetheless, all such deaths were tallied in the "inpatient" category.
If this is true, why do such "estimates" endure in the suicidology literature? Why do they become axiomatic and go unexamined? Perhaps we should be as concerned about the myths of suicidology as we are about the myths of suicide.
I agree with you. Lot of authors just cite previous data without bothering to re-examine them. And sometimes if they do, they "hit the wall". It is easier to just c/p previous data than to actually do some work...
I recently ran my dissent regarding the apparent prevailing wisdom on the incidence of inpatient psychiatric suicides by a TJC staff member. I learned that TJC does not feel that it captures 100% of inpatient suicides for two reasons: (1) hospitals either do not report some deaths that would seem to be suicides or quibble over the decedent's intent (e.g., citing the death as due to an autoerotic act); and (2) there are some inpatient facilities that the TJC does not accredit, In that regard, we are familiar with state hospitals that gave up accreditation. Nonetheless our contact agreed that the estimates we contested seem excessive.
In the UK the national confidential enquiery into suicide and homicides provides I believe very robust and uptodate evidence of the changes and trends our in Inpatient suicides. Along with the information on thiose opent to or who have had recent involvemnet with psychiatric services.
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness
As the UK’s leading research programme in this field, the Inquiry produces a wide range of national reports, projects and papers – providing health professionals, policymakers, and service managers with the evidence and practical suggestions they need to effectively implement change
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