Most of nearly 300 DDSN clients thought about suicide but did not attempt it, agency says

COLUMBIA -- Most of the nearly 300 disabled people who were reported last month to have attempted suicide actually thought about taking their life but did not act on it, the state's disabilities agency now says.

Last month, the state Department of Disabilities and Special Needs released a report on critical incidents filed in the system, which includes categories for assaults, aggression, accidents, fires, thefts, medication errors, law enforcement calls, hospitalizations and suicide.

During a discussion of the numbers at a July commission meeting, an agency official said while the category heading was suicide, what actually was reported was not suicides but suicide attempts. The agency reported 279 incidents in that category since 2012.

Thursday afternoon, Lois Park Mole, a DDSN spokeswoman issued a clarification, saying the "vast majority" of the incidents refer only to suicide "ideation," not actual attempts.

According to the Encyclopedia of Psychology, suicidal ideation is the "the contemplation of ending one’s own life."

"Suicidal ideation can vary greatly from fleeting thoughts to preoccupation to detailed planning," it notes. "Most people with suicidal ideation do not carry out an actual attempt, but some do."

Mole said there are three suicidal-related categories reported under the heading of suicide to the agency by providers and its facilities: suicide, attempted suicide and suicidal ideation.

She said there have been no suicides in the past five years.

The number of suicide attempts per year ranged from nine to 11, she said.

The "vast majority" of critical Incidents reported in the suicide category are verbalizations, she said. That rate has been "low," she said, rising from from about half a percent to about 1 percent of people in DDSN care in the most recently completed fiscal year.

On the report handed out to the public last month, under the heading of suicide, it shows incidents rising from 51 in fiscal year 2016 to 92 for fiscal year 2017. But officials clarified then that none of those incidents were suicides.

At the August commission meeting last week, a bar chart labeling different categories of critical incidents refers to them as "suicidal threats."

"This increase is attributed to a far greater need for mental health services, including psychiatric and behavioral services, for individuals now receiving services," Mole said about the increase in incidents.

DDSN oversees the care of thousands of people with intellectual disabilities, autism, brain and spinal cord injuries through a network of regional centers, county disabilities agencies and private service providers.

The original numbers were disclosed in July as DDSN's commission took up data related to South Carolina Mentor, a private residential provider whose new admissions were frozen last year for the third time by the agency.

In looking at key statistics for Mentor, DDSN also provided details on critical-type incidents for all providers as a group, details that some commissioners said they had not seen before.

Those who provide services for the agency are known as providers, which can range from small nonprofits to county agencies to for-profit firms.

Critical incidents is a catch-all phrase meant to include a variety of negative incidents.

Altogether there were 1,616 incidents for the fiscal year ending in June, up from 1,434 for the year before, according to the records. The number of such incidents has grown by more than 46 percent since 2012, according to the data.

DDSN emphasizes that critical incidents do not necessarily mean a provider of services has done something wrong and that some providers that serve more behaviorally challenged clients can expect to see more incidents.

DDSN Executive Director Beverly Buscemi said last month that suicide-related figures are impacted in part by dual diagnosis of some patients who are both intellectually disabled and also have mental illness.

She said one reason suicide-related figures are reported as an incident is so staff can check the data and be sure providers are equipped to address such incidents.

"I think resources are very challenging because having mental health professionals in this state that have a certain amount of experience with our population or the dual-diagnosis population is a challenge," she said. "It's not just a challenge for South Carolina. It's a challenge nationwide."

Sometimes getting access to a mental health professional can be difficult, she said, as is finding someone with clinical experience, especially with dual diagnosis.

"Do I think this is something that we need to be very, very careful and very mindful of? This is someone's life. Absolutely," she said. "I'm hesitant to ever answer a question that, yes, I'm completely satisfied with what a system does because I think there is always room for improvement. But do I think we have oversight checks in place to try and prevent that in every possible way? Yes, I do."

The commission earlier this month approved a budget request for fiscal year 2018-19 that includes $900,000 more for psychiatric and behavioral services.