A Comparative Study of Suicides Among in- and Out-Patients at Karasuyama Mental Hospital Between the Years 1959-1978

Abstract

The problem of suicides among mentally ill patients in open door treatment programs has received scarce attention. Of late, the psychiatric community has gone toward a more community-centered, open approach to treatment of the mentally ill; therefore, the opportunity for genuine social interaction has been broadened. When considering prevention of suicide, under the present conditions, it is important for one to understand the realities of suicides among mentally ill patients during the past 20 years. Among the mentally ill receiving the open door approach to treatment at Showa University's Karasuyama Mental Hospital, in patient suicides numbered 28; twenty five cases among these were schizophrenics. Out-patient suicides numbered 36 (20 were schizophrenics). This paper analyses and examines the relationship between suicides and age or the possible connection, if any, to the open door approach to treatment and, also, the scene of suicide, means used and motivation for the act were considered. Statistics show that the rate of suicides among the mentally ill is 20-fold that for the normal population. However, it was found that only 10% of the in-patients at our hospital had not attempted suicide at one time or another. But in spite of showing a rising trend, there have been only 2 successful suicides in our hospital. The ages of those attempting suicide were, for the most part, in the twenties or thirties and the average hospitalization period among these was less than five to fifteen years. But, in spite of the new open door approach to treatment at Karasuyama Mental Hospital and the resulting expansion of opportunities for meaningful social interaction, the rate of suicides among our out-patients has increased. By the time Karasuyama Mental Hospital started the open door system of therapy, there had been suicides within the closed door system, but there were not any within this system after 1967, when our hospital completed the open door system. Spring and Autumn are, generally, periods during which many suicides occur, but the above generalization does not hold true for the schizophrenic personality; they tend to commit suicide, in the case of those in the open door ward, during the daytime, and many carry this out away from the hospital. The means of suicide are often public, such as jumping in front of a train or from a building. These means are probably choosen because they assure success. In the case of patients within the closed door system, their means, of course, are totally dissimilar to those used by patients in the open door system. Many commit suicide. Great differences also existed between age and type of mental illness in the patients studied. Motivations for committing suicide are classified in this paper as follows: a) worsening of psychosis b) an awareness of a means of suicide c) lack of awareness that a particular act will result in death. Type A, in the case of out-patients, was the one. The others came under type B. In the case of Type B, findings bare out the importance of a more highly developed psychiatric system. Curing psychosis often results in eliminating the suicidal drive, but, in the case of Type B, close cooperation of patients’ families and other involved persons is needed to help the patient. In the case of Type C, this study showed that a potentially suicidal patient's cries for help must not be ignored. The problem of out-patient suicides hasj been showing marked increased tendency in the past years; therefore, now and in the future, an approach to the prevention of suicide among this group will be a major theme under study by the psychiatric community. © 1983, The Showa University Society. All rights reserved.