Contacts of suicidal neurotic and prepsychotic/psychotic patients and their significant others with public care institutions before the suicide attempt.

Interviews were conducted with 21 patients classified as neurotic or prepsychotic/psychotic, consecutively admitted to an intensive care unit (ICU) owing to suicide attempts by means of drug intoxication, with their 37 significant others and with care personnel concerning the patients' contacts with psychiatric, somatic or social care institutions before their suicide attempts. Nineteen patients came into contact with public care institutions between 1 and 6 months before attempting suicide; of these, 11 had contacts with psychiatric departments. Nine patients--chiefly those who were prepsychotic/psychotic--were in contact with public care institutions during the last 7 days before attempting suicide; of these, six had contacts with psychiatric departments. The neurotic patients' suicidal thoughts were seldom expressed in the contacts with care personnel, who consequently seldom noticed their suicidal tendencies. Contacts served to alleviate and lend structure to the patients' anxiety, promoted the mobilisation of their defences and temporarily concealed their hopelessness, depression and suicidal impulses. The personnel misinterpreted the patients' defences and considered the patients to be non-suicidal, capable and even strong. The prepsychotic/psychotic patients usually expressed suicidal thoughts in the form of indirect, non-verbal suicidal communication which was difficult to understand: it was recognised as such by their regular therapists, but seldom by staff who were unfamiliar with the patients. Consequently, suicidal risks were usually not recognised in emergency situations. The reasons why none of the significant others sought contact with public care institutions are discussed.