Commentary

This study, that makes use of the Danish national longitudinal registers, adds to the evidence of the risk of suicide on admission and discharge from an inpatient psychiatric service.^1,4 Examining the adjusted risk ratio for suicide across the times since psychiatric admission, Qin and colleagues found the risk of suicide in the first week following discharge was 102 times in men and 246 times in women.

The authors calculated the population attributable risk based on their findings and estimated that prevention efforts during the first week after discharge might impact up to 2.1% of male and 3.8% of female suicides. In spite of this transition being an ideal opportunity for selective prevention strategies, very little intervention research has been targeted towards recently discharged patients. These findings, however, do have implications for developing suicide prevention policies for hospital based inpatient psychiatric units.⁵ Every inpatient with a history of suicidal behaviour requires a risk assessment 24–48 hours before discharge to ensure that the acute risk of suicide has been attenuated. Links and Hoffman⁵ recommended that follow up within seven days of discharge be in place for everyone with severe mental illness or a history of self harm in the previous three months after release from an inpatient service. Patients with a history of self harm in the last few months are also recommended to receive no more than two weeks of medication at discharge from hospital. Individual care plans to specify actions that should be taken if a patient is non-compliant or fails to attend follow up appointments should be developed. Assertive outreach to prevent loss of contact, particularly with vulnerable or high risk patients must be incorporated within the individual care plans.