Lots of lurkers, but few new posts so far. Maybe I can get the ball rolling with one of my interests: preventing suicide, and malpractice & risk management issues in the care of suicidal patients.

Wrongful death (usually a pseudonym for suicide) is the most common "cause of action" in lawsuits against mental health professionals. That is, it is the most common reason plaintiffs sue us. Sometimes the lawsuit is not deserved; tragedy does not necessarily mean malpractice. Unfortunately, there are too many times when the lawsuit IS deserved, because the suicide could have been prevented if the patient's assessment and/or treatment had been within the standard of care (generally defined in most states as that care reasonably expected of similar professionals in similar situations, but pointedly not inadequate care, even if everyone in your community does it).

Recognition of suicide risk, adequate initial and follow-up assessment of risk, appropriate treatment, and adequate follow-up are the keys to protecting the patient and lowering risk to both the patient and the clinician. They're not rocket science, but they do require professional competence and a disturbing number of otherwise very nice colleagues don't do it right.

Notice I haven't said anything about "prediction" of suicide. We all know it's not generally predictable, but that's not the point. Loudly proclaiming "Suicide isn't predictable!" won't help you if you are sued. The relevant concept is "risk." Patients have a right to expect competent mental health professionals to recognize reasonably known suicide risk and take whatever steps are feasible to manage it.

I am reminded of a new book that features a couple of plaintiffs' lawyers who specialize in suicide cases (The Suicide Lawyers, by Risenhoover). I think there's a website for it at something like www.suicidelawyers.com. It's designed for lay readers, but has stuff professionals should know as well (if you're interested in how good plaintiffs' lawyers think). It doesn't seem to be written for sensationalism (in spite of the title and cover), but to try to decrease suicides by increasing both lay and professional awareness.

Comments? Ideas? . . .

Bill Reid