In the UK, Samaritans can be contacted on 116 123, or email jo@samaritans.org, or see samaritans.org. Other international helplines can be found at befrienders.org
I think it would be very difficult to evaluate whether psychiatric admission actually decreases risk of suicide in the short-term. I don't think a randomised trial would be ethical because there is a strong prior that admitting a suicidal person to hospital does reduce their short-term risk of suicide (i.e. there isn't clinical equipoise). I think observational studies will be prone to bias as those patients who are admitted to hospital will likely be different in key ways from patients who are not admitted.
Wow thanks for sharing that, it’s super interesting to hear (I’m guessing) a US perspective on this.
From the sounds of it, in the UK there is less threat of lawsuits and in the current NHS system, there is a big push back against admissions that are ‘not needed’ - there is a chronic shortage of psychiatric beds.
As a result the proportion of admissions (in London anyway) is heavily weighted towards acute psychosis rather than acute suicidality
I’ve also been told that UK community mental health services are more established - but don’t have personal experience of psychiatry elsewhere!
Yup I am US based! I'm still in training and am pulling from a small sample size of institutions/hospitals. Would love to hear from others (US or not). But my gestalt impression of the matter (and advice directly from mentors) is an impression of defensive medicine. Like I said though - I'm young and still learning!
Fwiw, I do think medicine in general in the US is more lawsuit heavy, but I haven't actually looked into numbers which I probably should 😬
Is the affinity with suicide risk assessment tin the US reinforced by the insurance system - i.e. is it easier to get reimbursed for treating someone at "high suicidal risk" than someone in an emotional crisis?
As someone in the 'trainee' stage, I have not had too much exposure to billing and insurance side of things. AKAIK, there is not a link between suicide risk stratification and reimbursement/billing-related-things
Excellent article, thank you.
it's a great piece! but It also highlights the issue with suicide prediction is that what to do is still VERY NOT GOOD. I wrote about this recently,.recently...https://open.substack.com/pub/thefrontierpsychiatrists/p/are-we-telling-the-truth-about-suicide?r=1ct8f&utm_campaign=post&utm_medium=web
Thank you for sharing this.
I think it would be very difficult to evaluate whether psychiatric admission actually decreases risk of suicide in the short-term. I don't think a randomised trial would be ethical because there is a strong prior that admitting a suicidal person to hospital does reduce their short-term risk of suicide (i.e. there isn't clinical equipoise). I think observational studies will be prone to bias as those patients who are admitted to hospital will likely be different in key ways from patients who are not admitted.
And rct has been done! But it's very hard to study
good to know. thanks.
Super fun read. I need to watch the 3B3B video. Reminds me of something similar I wrote (though less of a rational/baysean theme).
https://mindfulmonkey.substack.com/p/are-doctors-clairvoyant?s=w
Wow thanks for sharing that, it’s super interesting to hear (I’m guessing) a US perspective on this.
From the sounds of it, in the UK there is less threat of lawsuits and in the current NHS system, there is a big push back against admissions that are ‘not needed’ - there is a chronic shortage of psychiatric beds.
As a result the proportion of admissions (in London anyway) is heavily weighted towards acute psychosis rather than acute suicidality
I’ve also been told that UK community mental health services are more established - but don’t have personal experience of psychiatry elsewhere!
Yup I am US based! I'm still in training and am pulling from a small sample size of institutions/hospitals. Would love to hear from others (US or not). But my gestalt impression of the matter (and advice directly from mentors) is an impression of defensive medicine. Like I said though - I'm young and still learning!
Fwiw, I do think medicine in general in the US is more lawsuit heavy, but I haven't actually looked into numbers which I probably should 😬
Is the affinity with suicide risk assessment tin the US reinforced by the insurance system - i.e. is it easier to get reimbursed for treating someone at "high suicidal risk" than someone in an emotional crisis?
As someone in the 'trainee' stage, I have not had too much exposure to billing and insurance side of things. AKAIK, there is not a link between suicide risk stratification and reimbursement/billing-related-things