Abstract
Inpatient suicide accounts for a proportionately small but clinically significant fraction of all suicides. Psychiatric inpatient suicide rates in New Zealand, Australia, the United States of America (USA) and the United Kingdom (UK) range between 0.1 and 0.4 percent of all psychiatric hospital admissions. Studies show that those living with a mental illness have a greater risk of suicide; this risk increases significantly for inpatients, especially those with multiple admissions to hospital. Moreover, inpatient suicide causes immense physical, emotional and legal turmoil for family, friends and health professionals, as hospitals are expected to be safe. There are many strategies that can be implemented to prevent inpatient suicide; however, studies show that the environment of care is implicated in many inpatient suicides. This study aims to identify the environmental safeguards used to prevent inpatient suicide and their effectiveness. An integrative review of the literature was conducted, focusing on the environmental safeguards currently utilized in psychiatric environments to prevent inpatient suicide and suicide attempts, and their effectiveness. A comprehensive, systematic search of electronic databases was conducted to identify relevant literature. Nineteen articles, which met the review's inclusion criteria were critically appraised, using the Joanna Briggs Institute's suite of tools which resulted in thirteen articles being included in the review.
A six-step thematic analysis of extracted data was conducted, and the four main themes identified were:
1) Methods used
2) Common hazards
3) Off the ward suicides
4) Environmental safeguards
This study found that the use of environmental safeguards such as elimination of hanging hazards was associated with a significant decrease in the rates of inpatient suicide. However, environmental safeguarding can be expensive, ethically and morally insensitive, and lacking in patient voice and representation. Furthermore, environmental safeguards are interlinked with other procedural risk management strategies, and all these are more effective when implemented together.