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University of Iowa Hospitals considers adding barriers to ramps after suicides

Doctors say systemic problems with mental health system lead to sicker patients at hospitals

IOWA CITY — The University of Iowa Hospitals and Clinics may install barriers around parking ramps after four people attempted suicide — with three dying — by jumping off the upper decks in recent years.

Changes being considered for UIHC parking garages include barriers, artwork, educational displays or other “peaceful distractions,” said Scott Turner, co-chief operating officer for the 730-bed academic medical center. The hospital is working with an architect to determine which options work best for the spaces.

“Anything you can do to minimize the ease of jumping off the ramp can be helpful,” said Dr. Jodi Tate, a clinical associate professor of psychiatry.

Suicide Rate Increasing

More than 41,000 suicides were reported nationally in 2013, making suicide the 10th leading cause of death for Americans, according to the Centers for Disease Control and Prevention.

Iowa's suicide rate, which fluctuated around 11 deaths per 100,000 people throughout the 1990s and 2000s, has been climbing. In 2013, 14.4 people per 100,000 committed suicide in Iowa, and last year 13.4 people per 100,000 took their own lives, the Iowa Department of Public Health reported.

The UI Police started a security review of UIHC parking ramps in December, after a fourth person in six years jumped from a hospital ramp. In January, the state paid $250,000 to the family of a North Liberty man who jumped to his death from a ramp in 2009 while being treated for severe depression at UIHC.

UI officials said federal health care privacy laws prohibit them from saying whether the other people who have jumped from the ramps were patients.

Survey of UIHC Ramps

Any high place with easily accessible upper levels can be a magnet for suicide attempts.

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“The hospital ramps are 'an attractive nuisance' for those seeking high ground to jump and end their lives,” states the 19-page security review led by Alton Poole, a crime prevention specialist with the UI Police Department.

The three ramps included in the review — built in 1968, 1988 and 1997 — have retaining walls averaging four feet high, the report says. Poole suggests the UI add barriers, such as break-resistant glass or metal mesh, that would deter jumping without blocking sight into or out of the ramps.

Suicide nets similar to those proposed for the Golden Gate Bridge in San Fransisco also are an option for UIHC, but “would NOT give a warm welcome to a hospital,” Poole said.

The survey recommends signs, possibly digital, that send messages of hope or provide emergency phone numbers. The U.S. Department of Veterans Affairs has seen success with images of families or pets, the survey reports.

Barriers Proven to Stop Suicides

Barriers have been effective in deterring suicide at bridges and other high places because they thwart that first impulse and cause a suicidal person to reconsider, said Jill Harkavy-Friedman, vice president of research for the American Foundation for Suicide Prevention.

“When people are in suicidal crises, their thinking isn't clear and flexible,” she said. “If they lose the method (of suicide), they can't shift to another method.”

San Francisco area officials last year approved $76 million to fund suicide-prevention nets that will extend 20 feet on either side of the Golden Gate Bridge, from which an estimated 1,600 people have jumped since 1937, according to the LA Times. Research also has shown barriers added to bridges in Washington, D.C., and Bristol, England, haven't led to increased suicide attempts at other nearby unprotected places, the Washington Post reported.

Iowa's mental health needs

But slowing Iowa's suicide rate will take more than physical barriers and signs. It will require a deeper look at Iowa's mental health care needs — including a chronic shortage of psychiatrists, the UI's Tate said.

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A 2013 survey showed the state's psychiatrists are clustered in the most populated parts of Iowa, with almost two-thirds practicing in Polk, Johnson and Linn counties. Sixty-eight counties didn't have a single practicing psychiatrist.

Gov. Terry Branstad plans to close two of the state's four mental health institutions in December, which mental health advocates say will put more pressure on hospitals to take up the slack for crisis care.

“We had 25 requests for new evaluations each day last week,” Tate said. “It takes three to four months for that appointment. It has to be an emergency to get in earlier.”

By the time patients arrive for inpatient treatment, they are sicker and more desperate, Tate said.

Changes Follow 2009 Death

Kenneth Cabbage, 67, of North Liberty, was voluntarily admitted to the UIHC Psychiatric Unit for severe depression in May 2009 after he considered killing himself with a nail gun, according to lawsuit filed by the family in 2012. He was treated as an inpatient until June 19, 2009, when doctors discharged him, noting Cabbage was “no longer depressed” and “not suicidal.”

Cabbage received outpatient treatment until July 4, 2009, when he attempted suicide by overdosing on his medication, the lawsuit states. Cabbage continued to express suicidal thoughts to UIHC staff through July 22.

But when he requested a temporary leave to get ice cream with his wife July 27, staff granted the release.

When the couple was returning to the hospital, Cabbage got out of the car and told his wife he would meet her inside. He then jumped from the ramp and fell to his death.

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Cabbage's family claimed in the suit he shouldn't have been allowed to leave the hospital without UIHC staff so soon after expressing wishes to die. The January settlement requires the state to pay the family $250,000 and waive $38,000 in outstanding medical bills for Cabbage.

The UIHC since has updated suicide screening for patients and requires supervision for trips outside the hospital, Tate said. Staff members who accompany patients wear tracking devices and carry phones so they can call for help if needed.

The trips are considered therapeutic, allowing patients to be gradually reacclimated to the outside world, Turner added.

Through their attorney, the Cabbage family declined to comment on the UI's plans for the ramps or other changes.

Where to Call

The National Suicide Prevention Lifeline provides free, confidential help to people who feel suicidal or their loved ones.

Call (800) 273-8255 or go to suicidepreventionlifeline.org.

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