Risk Management Considerations When Treating Suicidal Patients

One of the most common claims against psychiatrists arises when a patient commits or attempts suicide. The holiday season is a time when suicides typically increase, and as we conclude our celebrations, it is important to address risk management issues when treating potentially suicidal patients.

An article published by Harvard Public Health referenced a 2001 study that surveyed patients between the ages of 13 and 34 who survived a near fatal suicide attempt. The respondents were asked how much time passed between making the decision to take their lives and the attempt. The study showed that 24 percent said in less than 5 minutes; 48 percent said less than 20 minutes; 70 percent said less than one hour; and 86 percent said less than eight hours, according to a 2013 report, “Guns and Suicide,” edited by Madeline Drexler.

Considering that it may be an impulsive act, and knowing a patient cannot remain on an inpatient unit indefinitely, how do you minimize risk when treating patients?

When evaluating whether the standard of care was breached in a suicide/attempted suicide case, courts often focus on foreseeability and causation. These issues are not always black and white. With respect to foreseeability, courts may consider whether the suicide could have been predicted, whether there was sufficient evidence for an identifiable risk of harm, and whether enough was done to protect the patient. Also, was it reasonable to foresee that the patient might die by suicide? And if the psychiatrist anticipated the potential for suicide risk, did he or she conduct a suicide assessment? The thoroughness of the assessment, as evidenced by the documentation, often becomes the critical issue in malpractice actions.

The best strategy is to document your assessment thoroughly. Some of what is important includes documentation of the following:

• Risk factors.

• Specific threats.

• Ability to follow through.

• Thought process on hospitalization: Why hospitalization is recommended or not. When indicated, discussion with family members or significant others.

This article cannot fully discuss all of the issues to consider when treating a suicidal patient and despite your best preventative measures. In the event that you may have a patient who dies by suicide, however, awareness of the recurring issues in these type of cases and the employment of appropriate risk management processes can reduce the likelihood of being sued and can increase the chances of successfully defending actions that may be filed. The following are some strategies that may minimize risk:

• Conduct complete timely/thorough risk assessments.

• Document thoroughly as you always do, including reasons for taking and not taking certain actions.

• Understand your state’s laws regarding breaching confidentiality and when you can do so.

• Understand your state’s laws regarding the discussion of firearms ownership and possession with patients.

• Understand your state’s laws regarding “duty to warn” and civil commitment.

• Should you have questions, consult an attorney or risk management professional. ■