Intensive Case Management in Suicide Attempters Following Discharge from Psychiatric Care

Abstract

Suicide risk is high in the first week, month and year following discharge from psychiatric inpatient settings. The decrease in care following discharge has been considered as contributing to the excessive suicide rate in this population. The aim of this research was to evaluate the impact of an intensive case management follow-up of these high-risk people for one year. Sixty males with a history of suicide attempts and psychiatric illness were recruited at discharge from a psychiatric inpatient setting at the Gold Coast Hospital, Queensland. Participants were randomly assigned to one of two conditions: Intensive Case Management (ICM) or Treatment As Usual (TAU). ICM featured weekly face-to-face contact with a community case manager and outreach telephone calls from experienced telephone counsellors. TAU participants were discharged under existing hospital practices. All participants completed assessment interviews at baseline, six and twelve months post-discharge. At the end of the twelve-month treatment phase, there was a dropout rate of 53.3% in the ICM condition, and 73.3% in the TAU condition, leaving a final sample of 22 (ICM=14, TAU=8). People in the ICM condition had significant improvements in depression scores, suicide ideation, and quality of life. ICM participants reported more contacts with mental and allied health services, had better relationships with therapists, and were more satisfied with the services that they did receive. No suicides were recorded in the twelve-month follow-up period. A few participants engaged in self-harming behaviours, though there were no differences between treatment conditions with regard to this aspect. Despite the high attrition rate and subsequent low sample size, initial indications are that intensive case management may be beneficial in assisting the post-discharge phase of high-risk psychiatric patients.