Understanding the Risks of Recent Discharge: The Phenomenological Experiences Trying to Survive While Living Under the Proverbial "Sword of Damocles"

Background: Evidence indicates that people whose mental health problems lead them to require psychiatric hospitalization are at a significantly increased risk of suicide, and the period of time immediately following discharge after such hospitalizations appears to be a particularly high-risk time. Aims: This paper reports on phenomenological findings from a federally funded, mixed-methods study that sought to better understand the observed increased risk for suicide following discharge from an inpatient psychiatric service. Methods: A purposive sample of 20 recently discharged former suicidal inpatients was obtained. Data were collected from the participants in hermeneutic interviews lasting between 1 h and 2 h and analyzed according to van Manen's ( 1997) interpretation of hermeneutic phenomenology. Results: Two key themes were induced: "Existential Angst at the Prospect of Discharge" and "Trying to Survive While Living Under the Proverbial 'Sword of Damocles'. "Each of these was comprised of five themes with the second key theme - the focus of this paper - encompassing the following: "Needing Postdischarge Support," "Feeling Lost, Uncertain and Disorientated," "Feeling Alone and Isolated," "Suicide Remains an Option," and "Engaging in Soothing, Comforting Behaviors." Conclusions: The authors conclude that early exploration of and reconciling patients' expectations regarding inpatient care for their suicidality would appear to be an empirically based intervention that could diminish the postdischarge risk for further suicide attempts.