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

by Simon, Robert I.

• ISBN13: 9781585621224
• ISBN10: 1585621226
• Edition: 1st
• Format: Hardcover
• Copyright: 2003-10-01
• Publisher: AMERICAN PSYCHIATRIC PUBLISHING INC

Summary

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.

Author Biography

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.

Table of Contents

Foreword	xiii
1 Suicide and Malpractice Litigation	1	(24)
Introduction	1	(2)
Understanding Malpractice Claims	3	(11)
Duty of Care	3	(2)
Standard of Care	5	(2)
Respected-Minority Rule	7	(1)
Direct Causation	8	(1)
Damage	9	(2)
"Volitional Acts" of Suicide	11	(3)
Defenses to a Malpractice Claim	14	(3)
Other Legal Actions	17	(1)
National Practitioner Data Bank	17	(1)
Importance of Clinically Based Risk Management	18	(2)
Clinically Based Risk Management	20	(1)
References	21	(4)
2 Suicide Risk Assessment	25	(36)
Introduction	25	(4)
Case Example	29	(6)
Discussion	35	(26)
Standard of Care	35	(2)
Systematic Suicide Risk Assessment	37	(4)
Suicide Risk Factors	41	(8)
Suicide Risk Assessment Methodology	49	(12)
Managed-Care Settings
Clinically Based Risk Management	61
References	55	(6)
3 Suicide Prevention Contracts	61	(18)
Introduction	61	(1)
Case Example	62	(5)
Discussion	67	(8)
Alliance Versus Contract	67	(4)
Other Viewpoints	71	(2)
Clinical-Legal Issues	73	(2)
Clinically Based Risk Management	75	(2)
References	77	(2)
4 Outpatients	79	(26)
Introduction	79	(2)
Case Example	81	(3)
Discussion	84	(14)
Evaluation	84	(3)
Treatment	87	(2)
Personality Disorders	89	(1)
Management	90	(6)
Suicide Warnings	96	(2)
Partial Hospitalization Programs and Intensive Outpatient Programs	98	(1)
Clinically Based Risk Management	99	(2)
References	101	(4)
5 Collaborative Treatment	105	(20)
Introduction	105	(1)
Case Example	106	(3)
Discussion	109	(10)
Competence, Licensure, and Insurance	111	(1)
Confidentiality	112	(1)
Treatment Roles	113	(2)
Medication Management	115	(3)
Patient Suitability	118	(1)
Clinically Based Risk Management	119	(2)
References	121	(2)
Appendix: Sample Letter From the Psychiatrist to a Psychotherapist	123	(2)
6 Inpatients	125	(48)
Introduction	125	(2)
Case Example	127	(5)
Discussion	132	(33)
Complete Psychiatric Examination	132	(3)
Suicide Risk Assessment	135	(5)
Treatment	140	(5)
Safety Management	145	(8)
Discharge and Aftercare	153	(11)
Documentation	164	(1)
Clinically Based Risk Management	165	(3)
References	168	(5)
7 Emergency Psychiatric Services	173	(18)
Introduction	173	(1)
Case Example	174	(3)
Discussion	177	(10)
Assessment	177	(6)
Management	183	(4)
Clinically Based Risk Management	187	(1)
References	188	(3)
8 Suicide Aftermath: Documentation, Confidentiality, and Survivor Care	191	(26)
Introduction	191	(1)
Case Example	192	(1)
Discussion	193	(18)
Documentation	194	(4)
Confidentiality	198	(6)
Patient Records	204	(2)
Suicide Aftermath	206	(3)
Aftercare for Suicide Survivors	209	(2)
Clinically Based Risk Management	211	(2)
References	213	(4)
Index of Legal Cases and Statutes	217	(4)
Subject Index	221