Treatment of suicidal patients: A risk‐benefit analysis

Abstract

A therapist may be held liable when a patient commits suicide if previous suicidal tendencies were observed but reasonable precautions were not taken. In order to reduce liability and enhance treatment effectiveness, therapeutic decisions can be critiqued by estimating the risks and benefits associated with different courses of action. An evaluation of risks and benefits can be used to guide decisions regarding assessment, hospitalization, medications, and discharge from the hospital. A risk-benefit analysis can help therapists utilize a broad range of treatment options while allowing patients the maximum degree of autonomy. Additionally, all aspects of treatment should be well documented, including information about the specific course of action chosen, other treatment options considered, and the therapeutic rationale for deciding which treatment plan was best suited to the patient's needs.

Despair Beyond Repair? Severity Of Hopelessness In Depressed Psychiatric Inpatients.

“…The efficient assessment of hopelessness is central to the clinical management of an acute suicidal crisis, and hopelessness can be monitored throughout the course of outpatient follow-up treatment after a suicide attempt. [41] Because of the close relationship between hopelessness and suicidal tendencies in depressed patients, it is important to assess and monitor pessimistic views over time. Clinicians may need to actively assess levels of hopelessness throughout the duration of treatment to ensure that patients do not cross the threshold from mild to moderate levels of hopelessness.…”

Cognitive-behavioral treatment of depression, part I: Assessment of depression and suicide risk

“…These contracts can help encourage therapist and client to openly discuss the issue of suicide and its prevention. However, these contracts may interfere with a caring therapeutic relationship by bringing a legal element into the therapy session (Overholser, 1995). Also, the contracts may provide the therapist with a false sense of security, allowing the therapist to feel the issue of suicide has been settled when it has not (Stanford, Goetz, & Bloom, 1994).…”

“…Although information about the client's problems and recent stressors can be helpful, from a legal view, the therapist must take careful notes about the treatment that is provided. From both therapeutic and legal perspectives, it is most important for therapists to record their evaluation of the risks and benefits of the planned intervention (Overholser, 1995). The therapist should examine a variety of possible treatment approaches, and determine which approach has the fewest risks and the greatest probability of treatment gains.…”

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

“…In this article, Jobes refers to competence as a central construct that guides ethical action. Competence is especially important when working with suicidal clients because of the risk of injury or death to the client, as well as the professional liability risks that could be incurred by the treating professional (Overholser, 1995).…”