It is well known that not all potentially suicidal patients declare their intentions to kill themselves. The generally well-known risk factors for suicide (gender, previous attempts, history of drug and alcohol abuse, lack of social support, older age, and the severity of depression) are never considered by the reviewers. The peer "re-viewers" appear not to be interested in what the psychiatrist (who has examined the patient in detail) has to tell them, and they tend to hide behind the cliches of the criteria to deny care. This puts an enormous burden on the psychiatrist, who nonetheless has to provide care for these patients without any compensation from the managed care company. The criteria lack any clinical or scientific validity and seem to take away the clinical expertise of the treating psychiatrist.