Ethical and competent care of suicidal patients: Contemporary challenges, new developments, and considerations for clinical practice.

Abstract

Clinical work with suicidal patients has become increasingly challenging in recent years. It is argued that contemporary issues related to working with suicidal patients have come to pose a number of considerable professional and even ethical hazards for psychologists. Among various concerns, these challenges include providing sufficient informed consent, performing competent assessments of suicidal risk, using empirically supported treatments/interventions, and using suitable risk management techniques. In summary, there are many complicated clinical issues related to suicide (e.g., improvements in the standard of care, resistance to changing practices, alterations to models of health care delivery, the role of research, and issues of diversity). Three experts comment on these considerations, emphasizing acute versus chronic suicide risk, the integration of empirical findings, effective documentation, graduate training, maintaining professional competence, perceptions of medical versus mental health care, fears of dealing with suicide risk, suicide myths, and stigma/blame related to suicide. The authors' intention is to raise awareness about various suicide-related ethical concerns. By increasing this awareness, they hope to compel psychologists to improve their clinical practices with suicidal patients, thereby helping to save lives.

Reflections on Suicide Among Soldiers

“…Moreover, clinical practices that actually do enjoy empirical support, such as suicide-specific cognitive behavioral therapy (Brown et al, 2005) and dialectic behavior therapy (Linehan, 1993), tend to be underutilized. I have elsewhere expounded that certain contemporary clinical practices related to suicidal risk have created a professional-even ethical-crisis for the field of mental health (Jobes, Rudd, Overholser, & Joiner, 2008). In any case, the Army's suicide crisis has clearly flushed out the overall lack of knowledge on the topic and has directly prompted the expenditure of considerable resources to support the best possible science to finally illuminate and guide our way forward.…”

The problematic label of suicide gesture: Alternatives for clinical research and practice.

“…Rather, we cite these examples to illustrate the fact that greater precision in our language for describing these behaviors is indeed possible. The use of more precise descriptors is consistent with the overarching goals of performing more competent suicide risk assessments and more clearly communicating the results to inform treatment planning, which are critical components of effective and ethical care for suicidal individuals (e.g., Jobes, Rudd, Overholser, & Joiner, 2008). …”

An Evidence-Based Clinical Approach to Suicide Prevention in the Department of Defense: The Collaborative Assessment and Management of Suicidality (CAMS)

“…In response to this disposition dilemma, Harborview Hospital instituted an NDA model to facilitate post-discharge care. Yet similar to many professional providers, NDA providers in this setting were not necessarily adequately trained to provide proper assessment and management of such patients (e.g., Fang et al, 2007;Jobes, Rudd, Overholser, & Joiner, 2008). To this end, the CAMS NDA study was developed to demonstrate: (a) the feasibility of CAMS within an NDA treatment model, and (b) that CAMS would result in significant reductions in suicidal risk and psychological distress as well as increases in reasons for living and hope during the course of treatment and at follow-up assessment in comparison to E-CAU.…”

“…As noted elsewhere the typical contemporary clinical response to suicidal risk is often inadequate (Jobes, Rudd, Overholser, & Joiner, 2008). For example, it is common for patients expressing even modest suicidal thoughts to be immediately hospitalized on an inpatient psychiatric unit.…”