Suicide Watch procedure?

This is for the hospital I work in- If the patient has attempted suicide and is now on a medical floor due to injuries sustained in that attempt. they will be on a one to one suicide watch - meaning that an aid or some other licensed personal (not their nurse) will be sitting in a chair by their bed 24 hours a day until the psych department determines that they are no longer a risk to themselves.
They can not leave the bedside until another aid or licensed personal relieves them and this means bathroom breaks and meal breaks.
NOTE: this is NOT for an inpatient mental health unit- this is when the patient is on a MEDICAL floor.

I don't know how a suicide watch works on an in pt mental health unit.

The above sounds plausible to me from my experience too... also, in general, even if there is not someone there 24 hours a day (which is likely), the nurses will likely place that person on '15 minute obs' which means someone looks in and checks on them every 15 mins to make sure nothing has happened to them. Usually the procedure for those who are still not 'stable' following a trauma. I mention this because while 24 hours observation might be the procedure, it does not mean that a hard pressed A&E ward will necessarily have the resources or manpower to fulfill this. If it is convenient for your story that she is left alone for a short while then you could have this being the case in which case the 15 minute rule may be in force or she may be placed where she is in full sight of the nurses station so someone can keep an eye on her while still doing other things.

Hospitals are generally set up to prevent suicide attempts - even ones not designed for psychiatric cases. Things like windows that don't open fully (so no one can throw themselves out) are common and they are very careful of where they keep things like sharp knives and pills. So they may not be too worried about an attempt when she is lying in a hospital bed well out of the way of any means to kill herself and likely too weak to move much anyway.

Not an expert here, thank Dawkins, but wouldn't denying a suicide attempt be a huge red flag for further observation, at the very least? I doubt any hospital would release an emergency psych patient who is (in the minds of the staff) delusional or in a fugue state.

sheadakota said:

...an aid or some other licensed personal (not their nurse) will be sitting in a chair by their bed 24 hours a day ...

NOTE: this is NOT for an inpatient mental health unit- this is when the patient is on a MEDICAL floor.

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I have a friend that was recently in a mental health unit because she was suicidal. She experienced the same: 1 to 1.

Sat Nam! (literally "Truth Name"--a Sikh greeting)

My husband had/has a friend who attempted suicide. He was the one to find her. I'm not able to answer all your questions, but I'll see if he can. I can tell you for sure that once her physical state had stabilized, they took her to the mental unit of a hospital, and that they could hold her for a week there without a commitment hearing. With the commitment hearing, they could hold her much longer. The rules might be different for a minor, but I'm not sure how.

Blessings,

Siri Kirpal

Medically, I doubt she'd have any serious injuries requiring hospital care. Or they'd be so serious, they wouldn't have to worry about the suicide watch.

Suicide by hanging is rarely an actual hanging, in the proper sense of the word. A drop hanging, properly done, snaps the spinal cord in the neck, result in immediate death. In a proper hanging, by the time the person hits the end of the rope, there's not a thing you can do to save them.

Most suicides by hanging actually involve suffocation. The rope (or whatever) around the neck compresses the throat, resulting in a restriction to the air flow. Depending upon how much compression there is depends upon how fast you die. But frequently the only injury is bruising. The trachea and larynx are fairly rugged. You'd need some rather advance hypoxia before the person would need treatment for that, and I doubt the person would be conscious.

So I imagine your patient would be in a psych ward, not a medical ward.

As far as remembering the suicide attempt, the doctor would attempt to ascertain why the patient doesn't remember it. Further would be how close to the event does the patient remember. The doctor then assesses why he/she thinks the patient doesn't remember. It can be a result of the hypoxia, it could be a result of the trauma, it could be blocking. Depending upon why the patient is blocking depends upon how big an impact it has on their release from the 72 hour hold.

Best of luck,

Jim Clark-Dawe

Sat Nam! (Literally "Truth Name"--a Sikh greeting)

[Taking dictation] My husband has dealt with 2 suicide situations: one successful and one unsuccessful. In both cases, he was the first person on the scene. After assessing the situation in each case, he called 911. With the living person, he stayed on the line with 911 until help arrived. Legally, he had no paperwork to fill out. He answered the 911's respondents' questions at the scene to the best of his ability.

Hospital: With the attempted suicide, the person was unconscious in the hospital for a few days. Visitors were allowed. And he does not know if there was any suicide watch instituted. The person has a history of depression and was examined by psychiatric personel in addition to regular MDs. The person was transfered to the local mental ward upon physical recovery.

[Mental Ward] At the mental ward, they did hold a commitment hearing and commited her to the state mental hospital for further treatment for up to 180 days. She started out in the "closed" ward on the mental unit, which has closer supervision. She was allowed visitors at regular visitor hours, but there were serious restrictions on what visitors could bring her as gifts. Books and papers were okay. No needles, scissors, pins, nothing sharp. Or rope like, including belts. They didn't allow a backpack either.

That's it. Except...this was for an adult; he doesn't have experience with minors who attempt suicide.

ETA: The hearing was within a week, but probably not within 72 hours.

Blessings,

Siri Kirpal

Chandy said:

I don't know how I forgot to mention this, but my MC is 16 years old, making her a minor. I don't know if that changes anything, but it might be worth knowing.

Thank you all so much for the replies so far! Definitely a lot of good information that will be really useful, and a lot to think about.



sheadakota, if you don't mind me asking, do you know how the patients in your hospital on the medical floor are evaluated? When they leave the medical floor, are they typical transported to a mental health unit or are they released to go home after a certain time has passed?

Thank you all again!

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When they are medically stable they are transported to an inpatient mental health unit for treatment- I believe for a suicide attempt this would be an mandatory admission- coud be wrong about that- I only work the medical side of the fence. But no, they would never be discharged to home if an attempted suicide was suspected - particulkarly if they were a minor,
How are they evaluated? Do you mean mental health wise? If so an in house Psychiatrist would evaluate them to determine if they are a danger to themselves or others.

Not sure if this will help ..

When I was in the hospital, they paired me with a roommate who was on suicide watch -- no special ward. Just a two person room. It was chaotic all the while she was there. First, a psychiatrist came in and asked a lot of questions (this was how I knew roommate was on suicide watch; it was very hard not to hear everything with only a curtain between us.). A pregnant nurse stayed to watch her the entire time until shift change and another nurse replaced her. The pregnant nurse read a book and didn't converse with my roommate. The one thing I really remember is that my roommate got on the phone and stayed on the phone. Talk, talk, talk, talk. The overhead lights stayed on, and she talked until well after midnight.

About a week later, I got a customer service call from the hospital about my stay. I mentioned the part about the phone and the time, and I got the impression the rep was surprised they'd given her a phone!

I was told this anecdote a couple of years ago by the individual in question, so my memory may not be perfect:

The individual (a friend of my husband) was talking with some of his friends on his college campus, and happened to use the phrase "I'll just kill myself" in a joking manner. He was overheard by an RA who, rather than take any chances, called the cops. Cops came, he told them he was joking, they didn't believe him (due in part to the freaked out RA saying it didn't sound like a joke), and he was carted off to the local psych ward. He spent a week there trying to convince people he had never been suicidal to begin with. Realizing that it was actually his denials that were keeping him there, he eventually switched his story to "I was suicidal, but I'm all better now, thanks." Since he didn't have much trouble "faking" his recovery, he was released after another week.

So, yeah, I'd say that the fact that your MC claims to have no memory of the event would make doctors more suspicious and protective rather than less.

Another part of your query -- if there is any suspicion of foul play, the patient would be moved to a private room and a female police officer stationed outside. Police would attempt to take a statement as soon as possible and perhaps call in a psychiatrist or youth counsellor. All visitors would be barred while the investigation was being carried out, family and friends questioned, any leads followed up, computers examined along with phones. .

For teens, I do know that medical staff are usually deliberately and quite cynically angry at the patient for the attempt. The idea being to scare them out of future attempts and show them that they don't get sympathy or attention for it (as most suicide attempts, especially in teens, are cries for attention).

I was a Community Mental Health Worker at a non-profit, and I once took a suicidal client in to the psychiatric Emerg (as she wanted) - the only thing they did was "form" her (make it mandatory that she had to stay until seeing a psychiatrist), and put her in a room with very little possibilities for suicide. I was less than impressed at the time. . .

Re: police procedure at the scene...

The scene would be processed (photographed, searched for evidence, etc.). Witnesses would be sought and interviewed, to include the first responders (EMTs, paramedics, etc.), and the treating doctors (ER).

Of course, whoever initially called about the attempt would be interviewed (typically considered a complainant for reporting purposes), especially if that person found the victim.

The investigation would continue until it is formally determined that this is indeed a suicide attempt rather than an assault (by another party). However, in some jurisdictions, suicide (and the attempt) may be deemed criminal offenses. Decisions to proceed would lie with the appropriate prosecutorial authority.

As a practical matter, few victims are ever criminally prosecuted. A civil commitment to a custodial mental health facility for an in-depth mental evaluation is the more likely scenario. Subsequent release would be at the discretion of the court, as advised by that jurisdiction's recognized competent medical authority. In the case of a juvenile victim, court oversight will typically be more intense; and any release protocol will involve a parent, legal guardian, and/or social services.

One of my clients once attempted suicide, and I was told to bring various things to her. It was just her clothes and books (I wasn't allowed to bring anything else).

One thing I noticed was that she was in a hospital gown while others were wearing just normal clothes. On that ward, patients on suicide watch were required to where hospital gowns so the staff could pick them out easier. Everyone else was allowed to where their normal clothes as long as they were approved by the nurses.

Coming very late to this discussion, apologies.

Jim CD, I agree that hypoxia by suffocation is the most likely way that a 'jump off the chair' hanging victim dies, but I think there's a bare possibility that unconciousness can occur if the carotids are compressed, cutting off the flow of blood to the brain. They're fairly protected, on the inside of some major tendons, so it would have to be because a rope knot is pressed directly into them or some such.

What happens when the rope compresses the jugular? Does that raise the venous blood pressure so high that no new blood can get into the head?

Two different routes to the big chill, perhaps.

I didn't go into a lot of detail in my answer. Starting point is exactly how is the pressure applied against the neck. Which depends whether the victim is leaning against the rope (or whatever) from the front, or more to the side. Most people, not doing a whole lot of research on the subject, figure the front of the throat is where they want the most pressure, and sort of fall forward. But there's an incredible variance in this. Further complicating this is the fact that some people can't tie a slip knot to save their live. Or to kill themselves efficiently. If the knot does not slip, then pressure is not equally applied to the neck.

Pressure to obstruct the carotid artery is about 5 kg., pressure to obstruct the jugulars is about 2 kg., and pressure to obstruct the airway is about 15 kg. So if pressure is evenly applied, the first to be obstructed is the jugulars, next the carotids, and finally the airway. The thinner the material used the more likely the pressure will be high enough as a thinner material will cut easily into the skin. The use of piano wire for hanging a victim is actually kinder then using a much thicker rope, if you do not do a dead drop.

Blocking the carotid will cause oxygen to not reach the brain, causing unconsciousness and a pale face. Blocking the jugular will cause an increase in blood in the brain, resulting in engorgement of the face and a blue color. Blocking the airway results in depriving the entire body of oxygen. From judicial hangings over the past few centuries, it's clear that any one of these were the cause of death, when a neck break wasn't caused. No one has done a statistical analysis to show what percentage each constituted. Nor has that analysis been done on suicide victims to the best of my knowledge.

But the net result is that there are three ways to die here. Suffocation is just the easiest to explain and what most people will think of. In reality, blocking the carotid will lead to cerebral hypoxia. With the arteries, the result will be cerebral edema leading to cerebral ischemia.

My guess is people who go unconscious quickly do so as a result of pressure on the carotid arteries, similar to a sleeper hold. Time to unconsciousness can be as little as fifteen seconds, to several minutes (with a blocked airway being the longest). Time to death appears to be about five minutes to over a quarter of an hour in the case of John Smith who received a reprieve about 15 minutes after the hanging.

Best of luck,

Jim Clark-Dawe