Service utilization by hospitalized suicide attempters with schizophrenia or depression in Montreal.

OBJECTIVE The purpose of this study was to analyze patterns of mental health-related service utilization before and after hospitalization for attempting suicide. METHODS This retrospective cohort study included all persons 15 years or older with a clinical diagnosis of schizophrenia (N=195) or depression (N=330) hospitalized in Montreal, Quebec, from April 2003 to December 2004 for attempting suicide. Data on the publicly managed health and social services system were retrieved from the linked administrative databases of Montreal's Health and Social Services Agency (April 2002 to March 2005). Twelve-month preattempt service utilization profile, health care contacts three months pre- and postattempt, and predictors of postattempt service utilization were analyzed for two diagnostic groups (schizophrenia and depression). RESULTS Specialized outpatient care and hospital emergency departments were the services most used by both groups before and after attempting suicide. Use of hospital emergency services as a primary care service did not adequately ensure aftercare, whereas prior contact with services and concurrent substance use disorder predicted greater service utilization postattempt among men but not women. CONCLUSIONS The publicly managed health and social services system in Montreal seems to respond rather well to severe suicide attempts, including those by men with a concurrent substance use disorder known to be at high suicide risk. However, better coordination among hospital emergency departments, primary care, specialized mental health services, and addiction services is needed in order to enhance continuity of care.