Dr. Phillip Resnick
An excellent suicide intervention framework is suggested by a recent article in Psychology Today titled “Strategies to Avoid a Malpractice Suit When a Patient Commits Suicide.”
The article, which covers psychiatrist Phillip Resnick’s presentation before the U.S. Psychiatric Congress earlier this week in Las Vegas, can be paraphrased to form a checklist, as follows:
- In order to make it nearly impossible for someone to harm himself or herself, do not leave a high risk person alone or unmonitored.
- Treat prior attempts and feelings of hopelessness as preeminent indicators of suicide risk.
- In determining risk, do not rely only on the person’s denial of suicidal ideas: Take into account
- the person’s actual behavior and
- input from his or her family.
- It is critical to assess protective factors, such as
- “a sense of responsibility to family …
- a positive support system,
- a therapeutic relationship, and
- good coping skills.”
It is interesting to note that the most common error in suicide risk assessment uncovered by litigation over suicide fatalities “is overreliance on a patient’s statements rather than on his observable behavior.”
A psychiatrist may assume a therapeutic alliance with a patient; however, about 25% of patients do not admit suicidal ideation to their health care provider. Once a patient makes up his mind to commit suicide, he may no longer view the doctor as an ally but as an adversary. Resnick said health care providers should not accept a disavowal of suicidal plans at face value — especially if the patient wants to leave the hospital.
Resnick also emphasizes the need for a suicidal person’s family to be involved in both determining and managing suicide risk.
“This is crucial,” he notes, “because a patient who is saying his final goodbye before killing himself has a 60% chance of saying goodbye to his spouse but only an 18% chance of notifying his therapist.” If a patient or a family member reports that the patient has a suicide plan, increased scrutiny is critical: 3 of 4 of these patients go on to attempt suicide.
Finally, the article states unequivocally that “no-suicide contracts may also create a false sense of security for the psychiatrist.”
“A no-suicide contract is alright as long as the psychiatrist doesn’t depend on it,” said Resnick. “I’ve seen nursing manuals that suggest that these no-suicide contracts can be used as a guide to determine whether the patient get privileges. I think that is just a mistake.”
[The abridged URL for this post is http://tinyurl.com/MalpracticeAdvice .]
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