hospitalization for suicide attempts

hospitalization for suicide attempts Given the stigma, managed care constraints, signifi cantly reduced numbers of
available inpatient beds, and other issues, hospitalizations are not the answer
for every suicidal student. Indeed, the need for hospitalization, management
while hospitalized, and postdischarge planning are all tinged with medicallegal
implications and liability issues for clinicians, other counseling center
staff, and the college administration.
When do you hospitalize a college student? First, a thorough clinical
assessment must be made based on all the facts—epidemiological factors, risk
and protective factors, prior history of self-destructive behaviors, psychiatric
diagnosis, and current status. The clinician needs to assess the benefi ts
of a hospitalization—safety, security, stability, possible removal from a toxic
environment, and the opportunity to reassess diagnosis, therapeutic protocols
and medications. The assessment must also review the negative consequences—
removal from a possible supportive living situation, potential
regression, loss of time in the classroom. If on balance the decision is made to
hospitalize, it should be shared with and explained to the student. The next
decision concerns whether the admission should be voluntary or involuntary.
At this point the clinician must discuss with the student issues of confi dentiality,
especially regarding notifi cation of “need to know” college administrators,
friends, roommates, and parents (or signifi cant others).

John, a pre-law senior, received disappointingly low LSAT scores in the
mail. Th at evening he got quite drunk; feeling despondent and hopeless,
he tried to jump out of his eighth-fl oor apartment window and had
to be restrained by his roommate. Brought by the campus police to be
evaluated by the on-call clinician, he now vociferously denied being suicidal
and strenuously argued that he couldn’t go to the hospital because
it would jeopardize his chances of going to law school. Th e clinician
weighed the costs and benefi ts of hospitalization. He preferred not to
send John to the hospital against his will, and John’s assurances that his
suicidal urges had passed raised the possibility that he could be safely
monitored and treated on an outpatient basis. On the other hand, the
impulsiveness and seriousness of his near attempt coupled with use of
alcohol had placed him in great danger, and it was quite likely that John
really hadn’t abandoned his suicidal wishes but was simply denying
them to avoid going to the hospital. On balance, the clinician decided
it would be irresponsible to gamble with John’s safety and so admitted
him involuntarily for further observation and stabilization.