Study: Suicide risk over 300x higher in first week after leaving psychiatric hospital

Released… to what?

A new long-term study following almost 100,000 people suffering from depression has shown that their risk of suicide is over 300 times higher than the average in the first few days after being discharged from a psychiatric hospital.

The study was conducted in Finland and examined almost 200,000 individual hospitalizations between the years 1996 and 2017. During the first three days after being discharged, the suicide rate for those who were admitted due to depression was found to be 6,063 per 100,000 person-years, or 330 times greater than the Finnish background rate. Between days four and seven after discharge, the rate dipped a bit but remained extremely high compared to the rate for the greater population: 3,884 per 100,000 person-years. Over the course of the next two years the rate continued to decrease steadily.

The study’s authors noted a number of risk factors, including recent suicide attempts featuring either hanging or use of a firearm; being male; being over the age of 40, and having a household disposable income in the highest tertile.

Suicides continue to mount

The suicide rate in the U.S. has been increasing steadily over the past few decades—between 2000 and 2017, the age-adjusted suicide rate rose from 10.4 to 14.0 per 100,000. Commenting on the findings of the Finnish study, Dr. Jacob Ballon of Stanford University said that if it had been conducted in the United States, the results would likely have been the same.

One might suspect that a sudden stoppage of psychiatric medications might be a key factor in the increased suicide rates, but, when asked what might be done to address the issue, Dr. Ballon did not focus on the importance of ensuring that patients continue, after discharge, to take whatever psychiatric drugs they were prescribed while in hospital. Instead, he stressed that creating a concrete post-hospitalization treatment plan and following-up on patients are what matter most:

There has to be a real effort to make sure that there is a solid plan on discharge for the person to be checked in with, within that first week after hospitalization [emphases added].

More psychiatry >> more death

Dr. Ballon did not specify either who should make the plan or who should do the checking-in. However, if what he envisages is having depressed people in more constant contact with psychiatry professionals, the evidence is that this actually correlates with a higher risk of suicide, though the correlation may be due to the more grave nature of the mental illness suffered by those committing suicide and the greater likelihood that it leads to medical intervention.

In fact, one large study dating back to 2014, studying people who committed suicide between 1996 and 2009, showed that:

• People taking psychiatric medication and with no other care were 5.8 times more likely to commit suicide;
• People who had contact with a mental health professional in outpatient care were 8.2 times more likely to commit suicide;
• People who had visited or been admitted to the ER of a psychiatric hospital were 27.9 times more likely to commit suicide and;
• People who had been admitted to a psychiatric hospital were 44.3 times more likely to commit suicide.

Deadly diagnosis

One of the key differences between those who have had contact with the mental health profession and those who have not is diagnosis. Being diagnosed, according to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association, is part-and-parcel of being “in treatment,” not just for insurance billing. Diagnosis is often seen as the admission of the “professional” that this is a problem that will always exist, and indeed, the majority of mental health professionals believe that mental health cannot be cured, but only managed.

Matt Stevenson was 32 years old when he committed suicide. He was a prolific writer on what is known as borderline personality disorder, having been “diagnosed” with BPD at the age of 20. After years of researching what is actually known about BPD and attempting to heal, he wrote in his suicide note that despite his intensive efforts to break free of psychiatric labels, he never entirely succeeded.

Recently, I continued to be extremely terrified of certain psychiatric studies, ideas, and diagnostic labels, and could not contain the fear around them … I was robbed of my life by these identifications.

Matt had close and loving family and an online community of like-minded people. Yet he felt unable to shake off the deterministic pronouncements of the “professionals.” Although he felt bereft of hope for himself, he continued to advocate for change that could benefit others:

The message should be that serious mental distress … is primarily caused by adverse psychosocial events … and that people can mostly or fully become free from these states with support and sufficient hope, that key thing I couldn’t feel at the end.

What helps?

What if you’re someone watching a loved one go through a severe crisis and you don’t know how to provide support or hope? Most suicide prevention hotlines will tell the caller to immediately contact emergency services. One mental healthcare professional suggests that this is not always the optimal response.

In an article titled “What Really Helps,” Paula J. Caplan, PhD describes one reason why referring someone to emergency services before you even hear them out can be damaging: it gives the person the message that whatever it is they’re dealing with is so huge and overwhelming that only the ER can possibly do anything for them. Urgent care may indeed be the best treatment option, but Caplan believes some thought must go into the process before recommending a ride in an ambulance.

She then stresses the importance of avoiding “psychiatric diagnostic terms” which can make a person “despondent” about their chances of recovering.

Similarly, she writes, even the word “therapy” should be avoided when possible. She does advocate for suggesting a person do something creative, like riding a horse, taking up painting, or going to the gym. Just don’t call it “therapy,” according to Caplan, because that’s something that only “sick” people do.

And keep in mind that another part of destructive labeling includes not just psychiatric labels but also “art therapy,” “music therapy,” etc. 

Caplan also suggests that those suffering from depression reduce or stop taking psychiatric drugs whenever possible. (Reduction should always be with the  guidance of a doctor who is generally supportive of tapering off psychiatric drugs and who can provide a plan to gradually reduce the dosage, as stopping psychiatric medications cold-turkey may be life-threatening.)

She cites a study of 329 suicide attempt survivors who, when asked what they wanted, replied:

Reducing stigma of suicidality, expressing empathy, active listening, range of treatment options including non-medication treatments, addressing root problems, bolstering coping skills, trauma-informed care.