To the Editor: Many thanks to Drs. Simon and Gutheil for their informative discussion of suicidal inpatients who suddenly improve (1). It is evident that the authors began with an unstated assumption that all patients hospitalized because of suicidal thinking, threats, or behaviors are, in fact, suicidal. As any emergency psychiatrist is aware, many people feign suicidality in order to gain admission to a hospital for a reason other than the need for mental health treatment. These individuals, often malingering, seek shelter or the avoidance of adverse consequences of homelessness or malfeasance. Such patients "fake bad" in the emergency department in order to gain hospitalization, in contrast to the patients described by Drs. Simon and Gutheil, who can be considered to be "faking good" later in their hospitalizations.
Such a dynamic, familiar to all clinicians who cover busy emergency departments, complicates decisions that must be made regarding the discharge of patients admitted with suicidal thoughts or behaviors who subsequently improve.
Dr. Roskes is director of forensic treatment at Springfield Hospital Center, Sykesville, Maryland. The opinions expressed represent those of the author and do not necessarily reflect the views of the State of Maryland Mental Hygiene Administration.
1.Simon R, Gutheil TG: Sudden improvement among high-risk suicidal patients: should it be trusted? Psychiatric Services 60:387—389, 2009