Management of the repeatedly suicidal patient

Although repetitive suicidal behaviour is commonly encountered, a relatively small number of very difficult patients engage in it. These individuals suffer primarily from severe personality disorders, as well as alcoholism and drug abuse. They are at high risk for eventual suicide. Although as a group they receive a great deal of hospital treatment, inpatient management is fraught with difficulties. Extended inpatient treatment is unlikely to be of benefit and may perpetuate the behaviour by leading to regression and excessive dependence on hospitalization. A model of management is described which couples the use of a brief-stay, crisis, inpatient unit and community-based outpatient treatment. Communication between institutions and agencies involved in the patient's care as well as coordination of services is essential. Acceptance by therapists of the risk of suicide and the realistic limitations to meeting these patients' needs can help such patients assume more responsibility and independence.