Franklin James Cook

Malpractice Advice Generates Suicide Intervention Checklist

In Intervention on November 7, 2009 at 12:23 pm

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 .]

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  1. I am sorry for all the souls that can only be healed by suicide and the survivors who strugle with grief and guilt. It strikes me as strange how little attention is paid to the medical profession that could help more if they were knowledgable and wonted to deal with suicidal patients. Most of psychiatrists and psychologists, refuse care and give lip service to suicidal patients who frequently have personality disorders that cannot be completelly if at all, treated by medications. These medical professionals don’t know where to send the patient that they cannot cure. Some of them refuse to talk to the family, that is essencial in being the support of the suicidal patient. I know because my son, Duncan, 36, shot himself on March 14, 2008, after years of unsuccessful search for the help he needed. There are so many components that bring the patient to a place where all is black. Finding good doctors is a matter of luck. Finding good clinics is a matter of luck. As a caregiver I tryed so hard to help him. In the end the only person who could help him to find peace was himself. And so he did. He is not in physical and mental pain any longer. I am. Why are doctors a protected spicies? They are not held responsible for their mistakes, at least here in Florida. The most vulnerable patients are left to their mercy. Where is a leader to get us all together, and there are milions of us. The medical system has to be changed. If doctors were held responsible and had to get a report card from their patients that is available to the public, may be they would think twice before disregarding my son’s cries for help, as at least 5 of them knew he was going to shoot himself. I know this is a long comment. My hope is that this would be sent to the doctors who are interrested in the genetic vs enviromental connections, as my son’s life is a perfect example of disfunctional family, bullying, genetics, and poor mental health system. His mind was brilliant, he was sensitive and did not know how to defend himself. Every 16 minutes there is a fatal suicide in USA. When is this going to stop? Whoever you are that is reading this comment, please, help the mentally ill and suicidal people and their caregivers. This cannot be done efficiently when we are all scattered around. We can be the power for change. Thank you for reading this mother’s grief. Mira

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