NOTES ON THE PROBLEMS OF SUICIDE AND ESCAPE

We have presented a study of suicide and escape emergencies occurring in the Sheppard and Enoch Pratt Hospital during the nine year period from 1930 to 1938 inclusive. During this period there has been a progressive fall not only in actual suicides and escapes but in the number of attempts as well as the number of persons engaging in those attempts. We find it impossible to attribute this change to either the general trend in the United States during the same period or to statistical data such as age, severity of illness of our patients, or the case load of patients per unit personnel over the period of time studied. A review of this period reveals changes in attitude toward these problems that appear to be more significant and which may be summed up as follows:

1. A recognition that every mentally ill person is a potential suicide or escape hazard.

2. That the best preventive of suicide or escape is a nursing personnel that is acutely aware of the hazards and methods involved.

3. That special precautions against suicide and escape may be so exaggerated as to bring about the attempt through suggestion.

4. A recognition of the fact that much of the discomfort of patients in mental hospitals arises from their sexual tensions in situations rigidly restricted to a homosexual environment. This can be relieved in part by increasing as far as possible the mixed sexuality of the milieu in which the patient finds himself.

5. A recognition that too great restriction of patients' activities for the purpose of preventing suicide or escape may so increase the patient's discomfort as to add to the urgency of his attempts.

6. That the assignment of a special nurse to a patient with a view to preventing suicide or escape is only justifiable when the drive exhibited by the patient is immediately active to a degree that renders this necessary and that such specials should be removed as soon as possible.

7. These attitudes should not interfere in any way with carrying out routine practical measures which remove or prevent the development of special hazards.

8. That the prevention of suicide is after all primarily a nursing problem and should be carried out by the nurses. To meet this responsibility it is necessary for them to have special instruction and grounding in the fundamental principles involved.