Mental Hospitals Cannot Prevent Suicides, Israeli Doctors Say

Expecting suicides to be prevented in all cases is like expecting doctors to cure patients every time, psychiatrists argue.

Dan Even
Dan Even
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Dan Even
Dan Even

The heads of Israel's psychiatric associations have published a new position paper stating that suicides in psychiatric hospitals cannot be prevented by doctors. The paper adds that a psychiatric hospital "is not an 'insurance policy' promising that a person will not find some way to end his life."

The paper also states that psychiatric patients whose judgment and perception of reality are not seriously impaired must take responsibility for their own decisions and actions, including a decision to commit suicide.

The paper was prepared by Prof. Moshe Kotler, the head of the Israel Psychiatric Association and director of the Be'er Ya'akov Psychiatric Hospital, and Dr. Yehuda Baruch, chairman of the forum of psychiatric hospital directors and director of the Abarbanel Mental Health Center, Bat Yam.

The two issued the paper in response to a case heard recently in the Haifa Magistrate's Court, involving the suicide of a 23-year-old patient at the Tirat Carmel Psychiatric Hospital in August 2009. The woman, a new immigrant from Russia and law school graduate, returned from a visit to her family in Russia in July 2009. After missing several menstrual periods, she went to a Clalit HMO gynecologist, who diagnosed her as psychologically disturbed. She was referred to the hospital, where she was diagnosed with bipolar disorder.

The woman refused to be hospitalized but agreed to receive treatment at the hospital's outpatient clinic. A week later, she tried to hang herself, but was rescued by her brother and taken to Rambam Medical Center, Haifa.

The woman's family, who subsequently sued Tirat Carmel for malpractice, said a doctor at Rambam persuaded her to go back to Tirat Carmel, because Rambam did not have a closed ward where she could be watched. She remained hospitalized at Tirat Carmel for three days, but amid complaints by her and her mother over her treatment, was released to outpatient care. However, her condition deteriorated and she agreed to be hospitalized in a closed ward. Six days later she was moved to an open ward.

The day she returned from the last of three furloughs, she hanged herself from a pipe with a bed sheet, in the hospital's petting zoo. The court heard testimony that another patient had hanged himself in the same place at the hospital, three years earlier.

In September 2012, Haifa Magistrate's Court Judge Zaid Falah ruled that there was cause to charge Tirat Carmel's acting director at the time and the director of the department in which the woman was hospitalized with negligent homicide.

Falah said the two had not been careful enough about ensuring that suicidal patients were kept from obtaining a sheet outside the ward and from access to a location previously used for suicide, and that they had not properly instructed their security staff to use cameras to monitor such areas and to patrol them.

However, before an indictment was served, the judge allowed the two to present arguments in their defense. The two persuaded the judge that they should not be charged, and he denied the prosecution's request for an indictment.

The judge said that when the possibility arose that staff could limit possibilities for psychiatric patients to commit suicide, "The list was so long that I realized it was impossible." The other patients' quality of life would suffer from the steps that would have to be taken, he noted.

According to Kotler, the position paper - published in an effort to prevent future lawsuits over suicides in mental health facilities - reflected the judge's final decision.

The paper stated that expecting suicides to be completely prevented was like "expecting a family doctor treating very sick patients to cure them every time and prevent any complications."

The test of a doctor was whether he "had done all that is expected of him given the complexities of each case," and not whether he had managed to prevent the suicide.

Hospitals threatened with such lawsuits would invest all their efforts into "creating a sterile environment with minimal conditions, with one goal - preventing patient suicides."

According to Kotler, "except for patients who have lost their freewill, among patients who are not psychotic, suicide is also an expression of the patient's will."

Prof. Zvi Zemishlany, director of Geha Psychiatric Hospital, Petah Tikva, said: "Thirty-five percent of the population has some psychological distress, but there is a distortion in public thinking that when a man commits some crime - for example, he batters his wife - he should be arrested. But when he commits suicide, the therapist is responsible. This is illogical."

A psychiatric hospital near Haifa.Credit: Doron Golan

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