Why are Suicide Rates High After Release From a Psychiatric Hospital?

One of the more robust predictors of suicidal behavior is recent release from inpatient psychiatric treatment. 

What is it about this stage of the treatment paradigm that leads citizens to attempt to self-kill? 

It is a topic I have examined since I walked out of an inpatient unit in 2000, drove to the Jersey shore, and threw myself from a rocky jetty into the pounding winter surf to end this life. 

The Suicidologist, Thomas Joiner, has created The Interpersonal Model to examine Suicidality to predict when a person will attempt suicide and why. His model uses Thwarted Belongingness and Perceived Burdensomeness to encapsulate the prevalent past models, from Durkheim’s Sociological model, to Beck’s Cognitive Sensitization and Shneidman’s Psychache and others. 

The Interpersonal model has been exhaustively tested and proven efficacious. It’s also been a tremendous tool in my development of an inner language to understand my suicidal behavior and the fixed logic of anguish that accompanies this mindset. 

But is the clinical language the same as the language of the experience itself? 

Is a person’s urge to end their life after inpatient hospitalization as simple as a Venn diagram measuring their Perceived Burdensomeness and Thwarted Belongingness and factoring it against levels of Capability? 

There is an “otherness” to both surviving a suicide attempt and having a psychotic episode that warrants hospitalization. 

This fractured state of existence is better captured in Kafka’s Metamorphosis than in the DSM-5. 

The chemist, novelist, and holocaust survivor Primo Levi, who eventually took his own life, discussed the phenomenon of Shame upon release from the camps. This monstrous Shame is a response to what one was turned into by an outside force, or, in the case of serious mental illness, a visceral enemy—an attacker that lives behind one’s eyes and in one’s blood. 

Could part of the phenomena of the greater risk for suicide upon release from the hospital be partly attributed to this drowning flood of Shame that grips patients as they enter the world and look back at what they were capable of sinking into, capable of becoming, capable of doing? 

The poet Alfred Alvarez called suicide the “logic of a nightmare.” When I crossed the threshold of the hospital door back into the world, I realized I was trapped in this nightmare. 

And while I did experience all the markers elucidated in Joiner’s comprehensive and effective model, it was much, much more. 

It was an existential agony that raised a question that seemed to only have one answer. As I washed back onto the dark, jagged rocks of the December Atlantic, I was extremely lucky to find out the answer was a lie. 

But the questions remain: Why? 

Why walk out of a hospital and run to my death?

The answers I have found are myriad and ever changing and my survival depends on the continued search.

Eric Arauz, MLER, is an international behavior health consumer advocate, trainer, and inspirational keynote speaker. He is a faculty member at the Rutgers-Robert Wood Johnson Medical School Department of Psychiatry, the Vice-Chairman of the current New Jersey Task Force on Opiate Addiction in citizens 18 to 25 years old, and a person with the lived experience of bipolar I disorder, PTSD, addiction, and suicidality. He is the SAMHSA 2012 "Voice Award" Fellow and the author of An American's Resurrection: My Pilgrimage from Child Abuse and Mental Illness to Salvation. 

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