Legal Advisor: Patient Suicidal Ideation: A Physician’s Legal Duties and Options
As many as 47,000 people in the U.S. die each year by their own hand. Among those, approximately 75% had seen a physician within a year before their death—45% to 66% within the prior month.
These statistics point to an unfortunate but unequivocal fact: many patients’ risk for suicide could be detected and care steps taken to save lives. While short-term suicide risk prediction is not possible, preventive care steps have been outlined as recommended practice by the National Action Alliance for Suicide Prevention as well as by The Joint Commissions (SEA 56).
More often than not, legal claims in the medical malpractice world deal with alleged failures to diagnose or properly treat a type of physical condition. However, physicians are often posed with dealing with a patient's mental health just as frequently as a patient's hypertension or cardiac issues. Patients presenting with suicide risk may have psychiatric conditions that have been identified or documented by the health system or they may not. How should physicians handle statements made by patients regarding suicide? What are the liability concerns if a physician does not take the proper steps to prevent a suicide risk from becoming a reality? What if a physician takes a statement too seriously and breaches confidentiality? Is there harm from overutilizing psychiatric hospitalization?
- Describe the recommended steps and limitations of assessing a patient’s risk for suicide.
- Explain why short-term prediction of the risk for suicide attempt or death is not possible with current state of science and why prevention steps are still effective and important to take.
- Restate why it is imperative to thoroughly document key relevant information pertaining to suicide risk assessment and steps taken.
- Consider options for clinical treatment planning, including when to hospitalize, when to refer to specialty care, and the preventive value of simply enhancing follow-up contact or communication.
- Discern whether disclosure of a patient’s suicide risk to a third party is a violation of confidentiality.
- Determine how to respond to a patient’s disclosure of suicidal thoughts or other indications of suicide risk in ways that help the patient and may increase the odds of the provider prevailing in any future malpractice litigation.
Christine Moutier, MD
Dr. Christine Moutier knows the impact of suicide firsthand. After losing colleagues to suicide she dedicated herself to fighting this leading cause of death. As a leader in the field of suicide prevention, Dr. Moutier joined AFSP in 2013, and it’s through her passion and commitment to the work that we see a lasting impact via research, education and support to communities across the U.S
She has testified before the U.S. Congress and provided multiple Congressional Briefings on suicide prevention, presented to the White House, spoken at the National Academy of Sciences, she co-anchored CNN’s Finding Hope suicide prevention town hall, and has appeared as an expert in The New York Times, The Washington Post, Time magazine, The Economist, The Atlantic, Anderson Cooper 360, the BBC, CNN, NBC and other print and television outlets. Throughout her career she has focused on training healthcare leaders, physicians, and patient groups in order to change the healthcare system’s approach to mental health, fighting stigma and optimizing care for those suffering from mental health conditions. In addition to co-founding AFSP’s San Diego Chapter, Moutier co-led a successful suicide prevention and depression awareness program for health science faculty, residents, and students, which featured AFSP’s groundbreaking Interactive Screening Program.
Since earning her medical degree and training in psychiatry at the University of California, San Diego, Moutier has been a practicing psychiatrist, professor and dean in the UCSD School of Medicine, medical director of the Inpatient Psychiatric Unit at the VA Medical Center in La Jolla, and has been clinically active with diverse patient populations, such as veterans, Asian refugee populations, as well as physicians and leaders with mental health conditions. She also served as co-investigator for the Sequenced Treatment Alternatives to Relieve Depression study (STAR*D), a large National Institute of Mental Health trial on the treatment of refractory depression. Moutier has authored articles and book chapters for publications such as the Journal of the American Medical Association, Academic Medicine, the American Journal of Psychiatry, the Journal of Clinical Psychiatry, Psychiatric Times, Depression and Anxiety, and Academic Psychiatry. Reviewer, Editorial Systems Manager, NEJM Group Education
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