Comparison of VA intentional and unintentional deaths.

This retrospective clinical study contrasts 22 unintentional ('accidental') deaths with 31 intentional (suicide) deaths of patients obtaining psychiatric care in a mid-sized VA Health Care system during 1993-1998. Unintended deaths were more frequently associated with addicting agents, particularly opioids. The number of such incidents increased from 1993-1998, a phenomenon that appeared to be associated with the implementation of managed care. These findings challenge rapidly changing psychiatric care systems to generate more effective treatment methods for dangerous addiction pathology despite decreasing numbers of substance abuse personnel per patient.