Risk management and life-threatening patient behaviors

Assessing and managing violence risk in outpatient settings

“…Warned targets can take steps to better protect themselves, and clinical anecdotes offer some support for this claim. 6 Because such warnings almost always involve a breach of confidentiality it is important that the clinician know whether such a course of action is permitted, required, or prohibited by law in the particular jurisdiction in which they practice (see Vandecreek and Knapp, 2000, for further discussion). Additionally, in those jurisdictions where such a course of action is permitted, clinicians should initially consider other means of reducing or controlling violence risk that do not require such a breach of confidence given the legal, ethical, and clinical mandates for maintaining confidentiality when possible.…”

“…In those cases where a client is considered to present a significant threat to him-or herself or another person and the law allows or requires the clinician to take action, such contacts can be made over the client's objection. Of course, such requirements and conditions vary considerably across jurisdictions, highlighting the need for mental health professionals to be familiar with the law of the jurisdiction in which they practice (see Vandecreek and Knapp, 2000, for a more detailed discussion).…”

“…Finally, an approach to thinking about how to respond to persons who are considered to be at increased risk for violence towards others as a function of their underlying emotional functioning or psychopathology will be reviewed. Not covered in this article are legal issues and responsibilities that may affect clinical practice (see Vandecreek & Knapp, 2000) or the literature regarding longer term risk assessment and management decision making that occurs in institutional settings (e.g., in the context of releasing individuals from psychiatric or correctional institutions, see, e.g., Edens & Otto, in press, for a discussion of this issue).…”

Imminent Suicide: The Illusion of Short‐Term Prediction

“…Fawcett et al (1990) describe acute, short‐term indicators that are statistically significant for suicide within 1 year of assessment. The authors cited above attempt to define a time frame for imminence , other authors use the term only in passing (VandeCreek & Knapp, 2000).…”

Homicide–suicide and other forms of co-occurring aggression against self and against others.

“…The standards of practice in the mental health disciplines therefore mandate a vigilant stance with regard to the risk of harm to self and the risk of harm to others. This has resulted in the development of distinct guidelines for the assessment of risk of harm to self and guidelines for the assessment of risk of harm to others (Joiner, Walker, Rudd, & Jobes, 1999; Kleespies, Deleppo, Gallagher, & Niles, 1999; Otto, 2000; Thienhaus & Piasecki, 1998; Tishler, Gordon, & Landry-Meyer, 2000; VandeCreek & Knapp, 1999). Yet these two forms of aggression frequently coexist not only in the case of homicide–suicide but also in the much more frequently occurring instances of nonlethal aggression.…”