Treating suicidal patients in an acute psychiatric day hospital: A challenge to assumptions about risk and overnight care

Abstract

Background: It is widely assumed that suicidal patients need to be treated in an overnight facility.

Aim: To test this assumption using quantitative and qualitative findings from a study of suicidal patients treated in a day hospital versus overnight care.

Method: Patients admitted to psychiatric wards were randomly allocated to a day hospital (141 patient) or conventional inpatient treatment (65 patients). Analysis of co-variance was used to test the hypothesis that patients with high suicidal ideation, particularly when living alone, would have less reduction in symptoms at the end of treatment period and following discharge, and higher readmission rates when treated in a day hospital as compared to an inpatient ward. In addition, descriptive case-by-case data were explored.

Results: Patients with high level of suicidal ideation, regardless of whether they lived alone, showed greater symptom reduction during a day hospital treatment. However this effect did not persist 3 or 12 months following discharge. However there was no significant difference in terms of days spent in readmissions after discharge. Two suicides occurred within the study period, one from each treatment group.

Conclusion: Our findings challenge the assumptions that overnight care is necessarily the best treatment option for acutely suicidal patients.

Keywords:

• Mental health
• risk
• suicide
• inpatient wards
• day hospital