Lack of continuity--a problem in the care of young suicides

The course of the psychiatric in-patient treatment received by 34 young people aged 15-24 years before their deaths from suicide was studied retrospectively on the basis of medical records. The quality of the care that they were given was appraised in terms of continuity, an important aspect of the care of young individuals during a period of dynamic development. There were two suicides among patients in child psychiatric care and 32 suicides among those in adult psychiatric care. Continuity of child psychiatric care was satisfactory, while the striking discontinuity in adult psychiatric care, in terms of contacts with doctors, therapists and other staff, with from 3 to 30 different doctors being involved during the period of care, may have been a factor contributing to the suicidal outcome in these cases. In total, 20 of the 34 young people had reported previously known suicide attempts, and notes concerning suicidal communication were mentioned in all but three of the records, while in only three of the records had any form of suicide-risk assessment been noted at the last care session before the suicide. Information about the suicidal process was thus available for most of these records but, as a rule, suicidal analyses were nevertheless lacking.