Rissmiller D J, Steer R, Ranieri W F, Rissmiller F, Hogate P
School of Osteopathic Medicine, University of Medicine and Dentistry of New Jersey.
Hosp Community Psychiatry. 1994 Aug;45(8):782-8. doi: 10.1176/ps.45.8.782.
The treatment of suicidal patients contributes to escalating mental health expenditures. Fiscal realities necessitate that cost-containment measures be implemented wherever possible. The authors reviewed the literature to delineate factors that impede cost containment for the treatment of suicidal patients and to outline strategies for controlling costs while improving the quality of care.
Psychological Abstracts and MEDLINE databases were reviewed. Retrieval and analysis focused on literature published between 1982 and 1992.
Five factors unique to the treatment of suicidal patients that impede cost containment were identified: the lack of a specific and cost-effective screening method to determine true risk of suicide, the high number of parasuicidal and malingering patients, revolving-door admissions of involuntary patients who become noncompliant with treatment after discharge, the adverse clinical consequences of further increases in existing discriminatory mental health benefits, and the medicolegal liability incurred in treating suicidal patients. The low frequency of completed suicides in relation to attempts and reported ideation indicates that most inpatients labeled suicidal are hospitalized unnecessarily. Thus inpatient treatment should be reserved for patients who make attempts of high lethality and patients with suicidal ideation who are at high risk because of other factors. Ideally, suicidal patients should be committed not to an inpatient facility but to a treatment network in which they can move appropriately between inpatient, day hospital, and outpatient care.
对自杀患者的治疗导致心理健康支出不断增加。财政现实要求尽可能实施成本控制措施。作者回顾了相关文献，以确定阻碍自杀患者治疗成本控制的因素，并概述在提高护理质量的同时控制成本的策略。
查阅了《心理学文摘》和MEDLINE数据库。检索和分析集中在1982年至1992年发表的文献。
确定了自杀患者治疗中阻碍成本控制的五个独特因素：缺乏一种确定自杀真实风险的具体且具有成本效益的筛查方法、大量准自杀和诈病患者、非自愿住院患者出院后不遵守治疗规定导致的反复入院、现有歧视性心理健康福利进一步增加带来的不良临床后果，以及治疗自杀患者产生的法医学责任。与自杀未遂和报告的自杀意念相比，自杀既遂的发生率较低，这表明大多数被标记为有自杀倾向的住院患者是不必要住院的。因此，住院治疗应保留给那些实施高致死性自杀未遂的患者以及因其他因素而处于高风险的有自杀意念的患者。理想情况下，自杀患者不应被送入住院机构，而应被纳入一个治疗网络，在这个网络中他们可以在住院、日间医院和门诊护理之间进行适当的转换。
