The allegedly suicidal patient in a general hospital

Of 50 emergency room admissions of patients believed to need protection against imminent suicide, the admission decision was, in 74% of the cases, solely on the patient's allegation (i.e., assertion without proof) that he was suicidal. Over half of the allegedly suicidal patients were chronic schizophrenic, and 20% were individuals with substance abuse problems. Only those allegers with affective disorders manifested any behavior or thinking after admission that could cause staff concern about suicide. Assuming that the suicidal thoughts and impulses described were products of intense, although transient, feeling and were in no instance feigned, extended hospital care did not appear indicated. Concern about possibility of suicide, if not based upon consideration of risk factors, diagnosis, and clinical judgment, may distract from attention to the patient's needs for long-term outpatient rehabilitation or psychotherapy, and may encourage episodic rather than continuous care for the chronically ill.