[Validity of hospitalization criteria in suicide behaviors: why, when, how?]

In the treatment of suicide, hospitalization is still considered one of the therapists' first choices. This alternative is chosen, on one hand, under the false belief that suicide can be predicted and that internment is the most effective intervention to prevent death. On the other hand, the situation elicits high emotional arousal, and therapists might be afraid of legal repercussion. Current experience shows that choosing hospitalization as an automatic response when treating a patient with suicidal behaviors can lead to significant negative effects, including iatrogenic ones. Among them are: stigma, lower perceived self-efficacy, the breakage of therapeutic alliance, and positive reinforcement of nonfatal auto-aggressive behaviors. Distinguishing between different situations included in the suicidal spectrum and considering suicidal behaviors as a dysfunctional mode of problem solving allow therapists to develop adequate strategies for each particular case, thus narrowing the indications to intern. Present article's main objective is to encourage professionals not to consider hospitalization as their first alternative, and that -in case there are firm criteria to intern- they could turn to it as part of a global strategy, minimizing negative effects and with special care in the continuity between the different instances (ambulatory, internment, and post discharge).