RISK MANAGEMENT TIPS FOR TREATING SUICIDAL PATIENTS

It is our experience that, in spite of the best efforts of mental health professionals, patients do attempt and commit suicide. There is nothing a therapist can do to prevent and predict suicide with 100% certainty. The following are several risk management tips:

• Perform and chart a complete suicide evaluation assessment. The most important risk management tip is to make sure your chart contains a suicide evaluation assessment. This suicide evaluation assessment should list the positive and negative risk factors for suicide. The chart should reflect the basis for your clinical judgment regarding the patient’s suicidality. Without a suicide evaluation assessment in the patient’s chart, suicide cases are difficult to defend.
• Maintain a strong therapeutic alliance with the patient. Obviously, maintaining a strong therapeutic alliance with a patient is of paramount importance in all therapeutic relationships. Developing a strong therapeutic alliance with a suicidal patient is a protective factor against suicide.
• Discuss the case with the patient’s family. We defend many cases when the family alleges that they never knew about the patient’s prior suicide ideations or attempts. Although a therapist must conform with confidentiality issues, it is always a good idea to keep the family informed as to the patient’s risk of suicide.
• Discuss and chart options for inpatient hospitalization. Plaintiff attorneys and plaintiff experts will criticize a physician for failing to hospitalize a potentially suicidal patient. Obviously, if the patient is not acutely suicidal, the decision to hospitalize is more complex. For patients who are chronically suicidal, we suggest discussing and charting the options for inpatient hospitalization and the patient’s response to those options.
• Seek a second opinion. For some reason, psychiatrists are the group of practitioners least likely to seek a second opinion. Since psychiatry is as much of an art as a science, the use of a colleague’s consultation for unique or difficult patients should be sought. Often psychiatrists become blinded by their own professional needs or persuasions. A second opinion by an experienced colleague if beneficial to both the therapist and the patient. Moreover, from a legal defensive standpoint, the psychiatrist who has obtained a second opinion has a built-in defense to any malpractice case that may be filed in the future. Many times plaintiff’s attorneys and experts will criticize a treating psychiatrist for failing to get a second opinion or consultation. It is an easy criticism to make. Obtaining a second opinion is easy, too.

It is important to remain objective following notice that one of your patients has committed suicide. It is acceptable practice to note in the chart the information you have received about the patient’s suicide. This should be charted in an objective fashion without any subjective comments. Do not change, revise or fudge your records following news of a suicide.

Clinicians often ask us whether it is appropriate to attend the funeral/wake of the patient. We believe it is appropriate to attend the funeral/wake, but no information should be exchanged at that time, with the exception of stating your condolences. Many times, communication with the family members is appropriate following a patient’s suicide. Often family members will feel grateful to the clinician who offers his services to them. Other times, the family is very vindictive and hateful of the clinician, since they believe the therapist “caused” the suicide.

SUMMARY

The goal of therapy is not to eliminate suicide risk, but to reduce suicide risk. There is no reasonable way to prevent a person who is determined to kill themself from actually doing it. No one can predict with 100% certainty when a certain patient is going to attempt suicide. The decision to hospitalize potentially suicidal patients is one of the most difficult decisions that therapists face on a day-to-day basis. Accordingly, the use of these risk management tips will be beneficial to all mental health professionals.