Suicide Prevention for High‐Risk Persons Who Refuse Treatment*

Abstract

ABSTRACT: A program was developed to exert a suicide prevention influence on high‐risk persons who decline to enter the health care system. There were 3,006 patients admitted to a psychiatric in‐patient service because of a depressive or suicidal state who were contacted to determine if the post‐discharge plan was followed. Half of those who refused their treatment program were contacted by telephone or letter on a set schedule. The contact was limited to expressing interest in the person's well‐being. Mortality in the contact group was compared with the no‐contact subjects and with the subjects who had accepted treatment, after 1, 2, 3, and 4 years. Suicidal deaths were found to diverge progressively in the three groups, the treatment subjects showing the highest rates, the no‐contact group coming next, and the contact subjects showing the lowest. The observed divergence between the contact and no‐contact groups provides tentative evidence that a high‐risk population for suicide can be identified and that a systematic approach to reducing that risk can be applied.