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studies of special post-hospital treatments that have demonstrated
some success: (1) Dialectical behavior therapy (extensive therapy and
group for one year), (2) Cognitive-Behavioral problem-solving (5
sessions in home), (3) home visits reinforcing attendance to outpatient
therapy, (4) medicine given by shots for six months, and (5)
Psychodynamic interpersonal therapy (4 sessions by a nurse in home).
Besides these treatment programs, Dr. Comtois concluded that several
changes in inpatient care might reduce the suicide and parasuicide
rates, such as: (a) keeping better records about the patient’s specific
means of self-injury, the dangerousness, the use of drugs or alcohol,
the presence of schizophrenia or bipolar disorders, and other high-risk
factors, (b) routinely evaluating the quality of care and outcome of
hospitalization, (c) improving the training of physicians and staff
dealing with parasuicides, (d) being sure treatment guidelines are
followed, (e) facilitating post-hospital care including meds, referral to
outpatient treatment and to support groups, and (f) providing after-
care, paid by Medicare, for distressed relatives (much as Hospice
does).
If you aren’t getting optimal service from your hospital, then
perhaps someone should complain to the head psychiatrist. Providing
marginal service at these crucial times is dangerous to the patients
and to the doctors. Suicide and parasuicide cases are among the most
often associated with malpractice suits. If you already have a therapist
before being hospitalized, then you should be OK because you can
quickly go back into individual therapy. If you are trying to make an
appointment with a new doctor who tells you there are no openings for
2 or 3 months, please tell him/her that you need to be seen right away
and that you were just in the hospital and still feel suicidal. They need
to know your condition in order to protect you…and you need to tell
them your mental condition. If that doesn’t work, see another
therapist. It is not unusual for suicide to occur during or shortly after
hospitalization. This is a dangerous time. Relatives and friends may
also be very distraught. They may need help too.
Cautions concerning the use of antidepressants
Although all depressed or suicidal people should get medical advice
and carefully consider using medication, it is unfortunate that many
people may believe (wish?) that all they need to do to control their
depression is see their family doctor and get some pills. There is a lot
of faulty thinking involved here: first, GPs have little training in
psychiatric disorders, such as depression or bipolar. Psychiatric or
Clinical Psychology specialists are needed. Secondly, many
psychopharmacology manufacturers say the physician should refer the
patient to psychotherapy whenever an antidepressive prescription is
written. That is seldom done. Third, it is generally believed that anti-
depressive meds take 6 weeks or so to start working. What protects
you during those 6 weeks? Fourth, it is well recognized that even the
best anti-depressive medication does not work with all patients, maybe
only with about two-thirds of them. What if you are within the 33%?
Fifth, what if your depression is not caused by “chemical imbalance”
