Every year in the United States, patients in general and psychiatric hospitals commit suicide. A new study in The Joint Commission Journal on Quality and Patient Safety provides the first data-driven estimate of the number of suicides in U.S. hospitals during National Suicide Prevention Week, Sept. 9-15, 2018. 

The study, “Incidence and Method of Suicide in Hospitals in the United States,” by Scott C. Williams, PsyD, director, Department of Research, The Joint Commission, and co-authors, analyzed national data sets, including the Centers for Disease Control and Prevention’s National Violent Death Reporting System (NVDRS) – Restricted Access Data for 2014-2015 and The Joint Commission’s Sentinel Event database from 2010–2017, to establish an evidence-based estimate of the number of hospital inpatient suicides and the methods used. 
 
Findings based on these data showed that approximately 49 to 65 hospital inpatient suicides occur each year in the United States, far fewer than the widely cited estimate of 1,500 per year. Of these, 75 to 80 percent were among psychiatric inpatients. Estimated suicide rates were:

• 3.2 per 100,000 psychiatric inpatient admissions

• 0.03 per 100,000 non-psychiatric inpatients 

Hanging accounted for more than 70 percent of suicides in both databases. Approximately half of suicides occurred in the bathroom, one third in the bedroom, and the remainder in the closet (4 percent), shower (4 percent) or other location (8 percent). The most commonly used fixture point was a door, door handle, or door hinge (53.8 percent). 

“Hospitalization is intended to provide patients a safe, protected environment designed to heal and stabilize them during periods of crisis, and suicides that occur within a hospital are considered to be sentinel events,” says Williams. “The Joint Commission is improving its methods for analyzing inpatient suicides to collect more detailed information so we can provide better guidance on  how hospitals can mitigate suicide risk more effectively.” 

The study’s findings support recommendations from The Joint Commission’s Suicide Expert Panel—a panel assembled by The Joint Commission that includes representatives from provider organizations, experts in suicide prevention and design of behavioral health care facilities, Joint Commission surveyors and staff, and other key stakeholders—that hospital settings associated with psychiatric treatment should be made ligature-resistant environments to decrease the risk of suicide by hanging. 

The study is available online free to the public on The Joint Commission Journal on Quality and Patient Safety website.