Attendance at Psychological Consultations following Non-Fatal Suicidal Behaviour: An Ethical Dilemma

Abstract

Rates of out-patient psychotherapy follow-up after hospitalisation for non-fatal suicidal behaviour (NFSB) are reported to be poor internationally. A study at a South African general hospital revealed that over a 12-month period 201 patients were admitted and referred for psychological consultation following NFSB. All first appointments were kept. However, only 43.5% of the 191 patients given subsequent out-patient appointments attended. No significant gender or age effects were noted. The results are discussed in the context of possible explanations for the high rate of non-attendance and the clinical value of the first in-patient psychological session. The authors also discuss some of the circumstances surrounding the first consultation and the ethical issues associated with the in-patient management of NFSB. We argue that the benefits of a first in-patient psychological consultation without explicit informed consent appear to outweigh the risks and harms, based on the ethical obligation of responsible caring.