Practical Pointers for Managing Suicidal Patients

· Include specific exploration of suicidal potential in examinations at the outset of treatment and at other points of decision during treatment.

· Explore past treatment. Obtain treatment records where possible for new or returning patients. Record attempts to obtain records if they cannot be obtained.

· Review patient records prior to lifting precautions or otherwise reducing the nature or intensity of treatment. Review the entries of other professionals as well as your own.

· Conduct follow-up discussions with staff members whose record entries may be inconsistent with treatment options under consideration. Include the basis for resolution of the inconsistency in a record entry of the decision.

· Instruct staff to notify you immediately if they are concerned about a patient’s potential for suicide.

· At the outset of treatment, or after breaks in treatment, consult family members or others close to the patient for information about the patient’s history, presenting condition, and life circumstances.

· Record all potentially relevant information provided by family and close friends.

· Be alert for, and respond to, developments in a patient’s life that may increase the risk of suicide.

· Address financial constraints directly. If recommended treatment is not financially possible, then attempt to find equivalent alternatives. Document the adequacy of the alternative ultimately chosen.

· Document all relevant information about a patient’s condition, treatment options considered, risk/benefit analysis performed, and the rationales for the treatment ultimately chosen.

· Never alter or destroy a patient record after an adverse incident.

· Develop a follow-up treatment plan that is consistent with a patient’s situation and abilities. Monitor patient compliance if another psychiatrist or professional has not yet assumed care.

· Familiarize yourself with the policies of all hospitals or other institutions/organizations where you provide treatment. Practice accordingly.

· The decision about type and amount of medication given to a suicidal patient - and the resulting record entry - should reflect the extent of your experience with the patient, your knowledge of the patient, the severity of the patient’s suicidality, and the extent to which physician prescribed medications may be of significance to the patient.

· Refill prescriptions for other psychiatrists’ patients with care. Review such refills with the psychiatrist if possible. Where such review is not possible, prescribe only enough medication to cover the patient until the psychiatrist returns or can be consulted.

· Terminate treatment with potentially suicidal patients with extreme care. Avoid terminating during periods of crisis. Consider termination during inpatient treatment, if termination is necessary.

· Prepare patients for scheduled absences and make provisions for coverage.

· Consider alerting family members to the risk of outpatient suicide when 1.) the risk is significant, 2.) the family members do not seem to be aware of the risk, and 3.) the family might contribute to the patient’s safety.

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The information contained in the web site does not constitute legal advice. If you are a Program Participant please call (800) 245-3333 for further risk management advice or risk management advice concerning a specific situation. For legal advice contact your personal attorney.