Preventive strategies and program evaluation methods for chronically mentally ill suicide attempters

In the course of defining treatment strategies and outcome criteria for a case management program serving the chronically mentally ill we reviewed the medical records of 282 patients admitted to University Hospital in Portland, Oregon following suicide attempts in 1979 and 1980. We found that these young people often had chronic psychiatric disorders, usually overdosed on medications, and spent a short time in the hospital-frequently in the intensive care unit. A substantial percentage of patients were clustered in the dowtown area of Portland and had not been treated previously at our hospital. Based on these findings we suggest a community based primary prevention program emphasizing case management for the chronically mentally ill. We also discuss a secondary prevention strategy in which overdose morbidity is minimized by adopting a cautious approach to dispensing psychotropic medications. We point out that readily available data on health care utilization following suicide attempts can be used to monitor such a program's effectiveness.