Assessing and Managing Suicide Risk: Guidelines for Clinically Based Risk Management

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American Psychiatric Pub, May 20, 2008 - Medical - 256 pages

Patient suicide is an unavoidable occupational hazard of psychiatric practice. Indeed, it is the rare clinician who does not struggle, even agonize, over the complex task of assessing and managing the risk of suicide in patients. Patient suicides account for the greatest number of malpractice suits filed against psychiatrists and for the greatest number of settlements and verdicts covered by professional liability insurers.

In this book, written by a clinician for clinicians, Dr. Simon, an established expert in psychiatry and law, offers A solid, easy-to-understand review of how medical malpractice law applies to patient suicides. He discusses the standards of care physicians must meet, the conditions associated with malpractice liability, and how best to minimize risks of litigation. Extensive references to peer-reviewed literature on suicide and recent malpractice cases, including those triggered by patient suicides, which give insight into the latest developments in both the scientific community and the courts. Much-needed practical advice, including advice on working with suicide risk assessments and suicide prevention contracts, on treating suicidal patients in various settings (outpatient, inpatient, collaborative, and emergency), and on coping with issues arising in the aftermath of a patient's suicide (documentation, confidentiality, and survivor care). Clearly defined risk management guidelines that will help clinicians avoid litigation or establish a sound legal defense if sued for malpractice. Numerous case examples that make the theoretical discussions and clinically based risk management guidelines that follow come alive.

Rich in advice that draws on the author's more than 40 years of clinical experience, this book serves as an essential aid to clinicians.

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Contents

Case Example
99
Discussion
102
Confidentiality
105
Treatment Roles
106
Medication Management
108
Patient Suitability
111
Clinically Based Risk Management
112
References
114

Other Legal Actions
13
Importance of Clinically Based Risk Management
14
Clinically Based Risk Management
16
References
17
Suicide Risk Assessment
21
Case Example
25
Discussion
28
Systematic Suicide Risk Assessment
30
Suicide Risk Factors
34
Suicide Risk Assessment Methodology
42
ManagedCare Settings
46
Clinically Based Risk Management
47
References
48
Suicide Prevention Contracts
54
Case Example
55
Discussion
60
Other Viewpoints
64
ClinicalLegal Issues
66
Clinically Based Risk Management
68
References
70
Outpatients
72
Case Example
74
Discussion
77
Treatment
80
Personality Disorders
82
Management
83
Suicide Warnings
89
Partial Hospitalization Programs and Intensive Outpatient Programs
91
Clinically Based Risk Management
92
References
94
Collaborative Treatment
98
Sample Letter From the Psychiatrist to a Psychotherapist
116
Inpatients
118
Case Example
120
Discussion
125
Suicide Risk Assessment
128
Treatment
133
Safety Management
138
Discharge and Aftercare
146
Documentation
157
Clinically Based Risk Management
158
References
161
Emergency Psychiatric Services
166
Case Example
167
Discussion
170
Management
176
Clinically Based Risk Management
180
References
181
Suicide Aftermath Documentation Confidentiality and Survivor Care
184
Case Example
185
Discussion
186
Documentation
187
Confidentiality
191
Patient Records
197
Suicide Aftermath
199
Aftercare for Suicide Survivors
202
Clinically Based Risk Management
204
References
206
Index of Legal Cases and Statutes
210
Subject Index
214
Copyright

Other editions - View all

Common terms and phrases

Popular passages

Page 71 - I am tired of tears and laughter, And men that laugh and weep, Of what may come hereafter For men that sow to reap: I am weary of days and hours, Blown buds of barren flowers, Desires and dreams and powers, And everything but sleep.
Page 97 - We must all hang together, or assuredly we shall all hang separately.
Page 104 - When the psychiatrist assumes a collaborative or supervisory role with another mental health worker, he/she must expend sufficient time to assure that proper care is given. It is contrary to the interests of the patient and to patient care if he/she allows himself/herself to be used as a figurehead.
Page iii - There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy.
Page xix - LITIGATION, n. A machine which you go into as a pig and come out of as a sausage.
Page 49 - Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: Findings from the Adverse Childhood Experiences Study.
Page 165 - ... in a real dark night of the soul it is always three o'clock in the morning, day after day.
Page 71 - The thought of suicide is a great consolation: by means of it one gets successfully through many a bad night.
Page 48 - Beck AT, Brown G, Berchick RJ, et al: Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients. Am J Psychiatry 147:190-195, 1990a Beck AT, Freeman A, and Associates: Cognitive Therapy of Personality Disorders.

About the author (2008)

Robert I. Simon, M.D., is Clinical Professor of Psychiatry and Director of the Program in Psychiatry and Law at Georgetown University School of Medicine in Washington, DC, and Chairman of the Department of Psychiatry at Suburban Hospital in Bethesda, Maryland.

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