¹Chiromo Hospital Group, Psychiatry, Nairobi, Kenya, ²University of Nairobi, Psychiatry, Nairobi, Kenya, ³Agakhan University Hospital, Brain and Mind Institute, Nairobi, Kenya

Background: Suicide and suicidal behaviour are higher among psychiatric inpatients than in the general population. Patients in forensic units have the duality of mental illness and incarceration. Few studies have looked into the prevalence of suicidal behaviour and patterns of psychiatric morbidity among the patients admitted to forensic units. This study examined the prevalence of suicidality and associated psychiatric morbidity among patients admitted to the maximum-security unit at a specialised Kenyan tertiary referral facility.

Aims & Objectives: Broad objective: To establish how common suicidal behavior is among individuals admitted to Mathari Teaching and Referral Hospital’s Maximum-Security Unit.
Specific objectives:

• To identify the patients' sociodemographic traits who are admitted to the Mathari Teaching and Referral Hospital’s Maximum-security Unit.
• To examine the psychiatric conditions that patients admitted to Mathari Teaching and Referral Hospital’s Maximum-Security unit suffer from.
• To appraise whether suicidal behavior is present among patients admitted to Mathari Teaching and Referral Hospital’s Maximum-Security unit.

Method: This was a descriptive cross-sectional study among patients admitted to the Maximum-Security Unit (MSU) at Mathari National Teaching and Referral Hospital. It is the only hospital in the country that has a maximum security unit dedicated to forensic psychiatry. All patients admitted to the Maximum-Security Unit during the study period who met the inclusion criteria and consented to participate were recruited.
A researcher-developed sociodemographic questionnaire was used. The Mini-International Neuropsychiatry Interview (MINI), a systematised clinical assessment developed principally for significant mental health conditions as designated in DSM and ICD , was also conducted. A suicide Behavior Questionnaire- Revised (SBQ-R) questionnaire was then utilised to evaluate lifetime suicidal ideation and attempts, frequency of suicidal thoughts in the past year, threat of suicidal behaviour, and future likelihood of suicide attempt.

Results: The study had a total of 99 participants (92 male, 7 female). Most of the patients were aged 30-39 years (32%). From the SBQ-R questionnaire, 16% of the patients were at increased risk of suicide. 35% had suicidal thoughts at least once in their lifetime, with 65% of these having had suicidal thoughts in the past year. 20 patients (20%) reported having attempted suicide. The most prevalent psychiatric morbidity (85%) was psychotic disorders. Having no formal education, unemployment, a family history of mental illness, and psychosis were associated with increased risk of suicide in the study

Discussion & Conclusions: Forensic psychiatry patients face a heightened risk of suicide due to the combination of mental illness and incarceration. The prevalence of suicidal behaviour among forensic psychiatry patients was higher than that of the general population. This study, among forensic psychiatry patients, found that having lower levels of education was significantly linked to a higher risk of suicidal behaviour. Psychiatric morbidity, including psychosis, alcohol and other substance use disorder, and major depressive disorder and psychosis was also associated with suicidal behaviour.Our findings indicate that forensic psychiatric admissions were overwhelmingly male and concentrated in early to mid-adulthood. Psychosocially, men may experience greater difficulty expressing emotional distress and are less likely to seek help early, all of which increases vulnerability to both incarceration and suicidal behaviour.