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Article   |    
Factors Complicating Cost Containment in the Treatment of Suicidal Patients
David J. Rissmiller; Robert Steer; William F. Ranieri; Frances Rissmiller; Paul Hogate
Psychiatric Services 1994; doi:
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School of Osteopathic Medicine of the University of Medicine and Dentistry of New Jersey; Department of Psychiatry, UMDNJSOM, Suite 100, 2250 Chapel Avenue West, Cherry Hill, New Jersey 08002

School of Osteopathic Medicine of the University of Medicine and Dentistry of New Jersey

Our Lady of Lourdes Medical Center in Camden, New Jersey

1994 by the American Psychiatric Association

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Abstract

Objective: The treatment of suicidal patients contributes to escalating mental health expenditures. Fiscal realities necessitate that cost-containment measures be implemented wherever possible. The authors reviewed the literature to delineate factors that impede cost containment for the treatment of suicidal patients and to outline strategies for controlling costs while improving the quality of care.Methods: Psychological Abstracts and MEDLINE databases were reviewed. Retrieval and analysis focused on literature published between 1982 and 1992.Results and conclusions: Five factors unique to the treatment of suicidal patients that impede cost containment were identified: the lack of a specific and cost-effective screening method to determine true risk of suicide, the high number of parasuicidal and malingering patients, revolvingdoor admissions of involuntary patients who become noncompliant with treatment after discharge, the adverse clinical consequences of further increases in existing discriminatory mental health benefits, and the medicolegal liability incurred in treating suicidal patients. The low frequency of completed suicides in relation to attempts and reported ideation indicates that most inpatients labeled suicidal are hospitalized unnecessarily. Thus inpatient treatment should be reserved for patients who make attempts of high lethality and patients with suicidal ideation who are at high risk because of other factors. Ideally, suicidal patients should be committed not to an inpatient faciity but to a treatment network in which they can move appropriately between inpatient, day hospital, and outpatient care.

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