Hospital & community psychiatry
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The authors' goals were to describe the characteristics of suicides committed by inmates in custody of the New York City Department of Correction between 1980 and 1988. ⋯ The authors recommend that all inmates with a psychiatric history or potential suicidality be identified and linked with ongoing mental health services while incarcerated, that potentially suicidal inmates never be housed alone in a cell, and that correctional staff be trained to recognize potentially self-destructive inmates and to prevent suicide.
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Serious clinical and risk management problems arise when indigent patients with acute medical conditions are transferred from general medical hospitals or emergency departments to public psychiatric hospitals that are ill equipped to provide medical care. To combat such practices, referred to as dumping, Congress included measures in the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) prohibiting such transfers. ⋯ The key to preventing dumping is to educate referral sources to limitations on the medical care available at the receiving hospital and to discourage negligent patient transfers by enforcing COBRA. Public hospital staff and legal counsel who become familiar with COBRA's provisions can develop an antidumping strategy.