Death Proof


"Do you not know that your body is a temple of the Holy Spirit, who is in you, whom you have received from God? You are not your own, you were bought at a price. Therefore honor God with your body."
     - 1 Corinthians 6:19-20

“I know, too, that death is the only god who comes when you call.” 
     - Roger Zelazny, Frost & Fire, 1989

"[…] Far more people actually kill themselves in psychiatric hospitals than they do in highly publicized or exotic places. Five to 10 percent of all suicides, in fact, take place in mental hospitals. It may seem strange that such high rates should exist in places specifically designed to protect patients from harming or killing themselves. But in many ways, it is no more strange than the fact that there are high death rates in intensive care units or on oncology wards. Psychiatric hospitals exist to take care of the most severely ill and those most at risk for suicide. 

A common reason for admission to a mental hospital is having attempted suicide, and attempted suicide is, as we have seen, the single best predictor of subsequent suicide. A substantial risk of suicide is also one of the few reasons people can be held in hospitals involuntarily. 

Although many precautions can be taken by medical staff to protect patients, there is no way, short of intolerable violations of privacy and freedom, to protect everyone. The line between civil liberties and preservation of life is a controversial one. Acutely suicidal patients are kept under close observation, often on a locked ward. Windows on such wards are usually unbreakable and unopenable, electrical cords are kept as short as possible, and ‘breakaway’ hooks and shower rods, designed to break off at low weights, are used. Patients are searched for sharp objects and drugs, and matches, lighters, nail polish remover, mirrors, bottles, scissors, belts, and shoelaces are removed from their possession."

"Physical observation of suicidal patients is intense, with levels varying according to the assessment of the suicide risk. In one-to-one observation, the patient is continuously watched and accompanied by a staff member even when the patient is showering or using the toilet. The physical proximity is kept close, sometimes no further than arm’s length, in order to allow a quick response in case of a sudden or impulsive move. Occasionally, a single nurse may observe two or three suicidal patients at the same time; if the suicide risk appears to lessen, a patient will then be put on five-, fifteen-, or thirty-minute ‘checks’ These checks consist of staff members monitoring the whereabouts and well-being of the patient on a frequent but not continuous basis."

"Were suicidal patients able or willing to articulate the severity of their suicidal thoughts and plans, little risk would exist. But this is not the case. Patients determined to die may present a clinical picture greatly at variance with how they actually feel or what they intend to do. They may move quickly and with desperate ingenuity. As nineteenth-century psychiatrist Emil Kraepelin wrote in his classic text, Manic-Depressive Insanity:

‘Only too often the patients know how to conceal their suicidal intentions behind an apparently cheerful behaviour, and then carefully prepare for the execution of their intention at a suitable moment. The possibilities at their command are numerous. They may, while deceiving the vigilance of the people round them, drown themselves in the bath, hang themselves on the latch of the door, or on any projecting corner in the watercloset, indeed even strangle themselves in bed under the cover with a handkerchief or strips of linen. They may swallow needles, nails, bits of broken glass, even spoons, drink up any medicine, save up sleeping-powder and take it all at one time, throw themselves downstairs, smash their skull with a heavy object and so on. A female patient by sticking in pieces of paper managed to prevent the upper part of a window, where there was no grating, being properly shut, and then threw herself down from the second storey in an unwatched moment. Another who was shortly to have been discharged, was alone for a few minutes in the scullery; she took a little bottle of spirit and a match from the cupboard, which had been left open through negligence, and having poured the spirit over herself set herself on fire.’"

"In the 1930s, Gerald Jameison and James Wall, at Bloomingdale Hospital in New York State, described the varieties of suicide methods used by patients in their hospital: twisted cords round the neck; two neckties attached to plumbing fixtures in the toilet; three handkerchiefs attached to the hinge of a closet door; a curtain tied around the throat and then attached to a window sash; cut throats from razors or window glass; and a cut femoral and radial artery with a piece of glass from a tumbler. (Sylvia Plath, who had been hospitalized after a nearly lethal suicide attempt, described in her autobiographical novel, The Bell Jar, the guile attendant to suicidal thought: ‘A maid in a green uniform was setting the tables for supper,’ she wrote. ‘There were white linen tablecloths and glasses and paper napkins. I stored the fact that they were real glasses in the corner of my mind the way a squirrel stores a nut. At the city hospital we had drunk out of paper cups and had no knives to cut our meat.’)"

"Hanging and jumping are by far the most common methods of suicide used by psychiatric inpatients, and being under staff supervision is no guarantee against self-inflicted injuries and death. Psychiatrists Jan Fawcett and Katie Busch, in a Chicago-based study of patients who had committed suicide while in the hospital, found that more than 40 percent had been on fifteen-minute checks at the time they killed themselves. Fully 70 percent of those who killed themselves had denied, prior to the act, any suicidal thinking or plans. 

The reality of treating seriously ill and potentially suicidal patients is that difficult clinical decisions have to be made each step of the way. When should a patient first be taken off constant nursing observation and placed on fifteen- or thirty-minute checks? At what point can a patient first be allowed off the ward unaccompanied or given a pass to go home for the weekend? Prediction is imperfect, and patients who are desirous of dying dissemble."

"Research indicates that more than half the patients who kill themselves in psychiatric hospitals had been described by nursing or medical staff, just before their suicides, as ‘clinically improved’ or ‘improving.’ Indeed, nearly 50 percent of those who commit suicide while on a ward, or immediately after discharge from the hospital, had been assessed as nonsuicidal at the time of admission. The days early in hospitalization and those leading up to discharge are particularly high-risk periods for suicide. The time prior to leaving the hospital is often laden with concerns about rejection by family and friends, loneliness, a still turbulent clinical course (often characterized by volatile mood cycling and an exceedingly uncomfortable restlessness, agitation, and irritability), concerns about job problems or unemployment, and fears about being able to manage outside the hospital. Often caught in the dilemma of being too well to be in the hospital but not well enough to deal with the realities and stresses of life outside, as well as having to contend with the personal and economic consequences of having a serious mental illness, patients sometimes feel utterly hopeless and overwhelmed, and kill themselves. Hospitals can provide sanctuary and medical care; they can save the lives of many who are suicidal. But they cannot save everyone."

 

IMAGES TAKEN FROM "SUICIDE PREVENTION IN HEALTH CARE FACILITIES: ENVIRONMENTAL SAFETY RECOMMENDATIONS", PUBLISHED BY THE MINNESOTA DEPARTMENT OF HEALTH, STRATIS HEALTH, AND THE MINNESOTA HOSPITAL ASSOCIATION, OCTOBER 14, 2015; "PATIENT SAFETY STANDARDS, MATERIALS AND SYSTEMS GUIDELINES RECOMMENDED BY THE NEW YORK STATE OFFICE OF MENTAL HEALTH"; BEHAVIORAL SAFETY PRODUCTS (BESAFEPRO.COM

TEXT TAKEN FROM NIGHT FALLS FAST BY KAY REDFIELD JAMISON, 1999 

ADDITIONAL RESOURCES: NORVA PLASTICS; ACORN ENGINEERING COMPANY; WEIZEL SECURITY; "CHECKLIST FOR THE 'SUICIDE-RESISTANT' DESIGN OF CORRECTIONAL FACILITIES", BY LINDSAY M. HAYES, NATIONAL CENTER ON INSTITUTIONS AND ALTERNATIVES, 2011; "REDUCING BATHROOM SUICIDE RISK: YOUR FIXTURES MATTER", ANDREW1, VANDALPROOF.COM, NOVEMBER 16, 2014; "DESIGN GUIDE FOR THE BUILT ENVIRONMENT OF BEHAVIORAL HEALTH FACILITIES" BY JAMES M. HUNT AND DAVID M. SINE