SUICIDE RISK

"Psychiatrists have no special knowledge or ability with which to predict dangerous behavior. Studies have shown that even with patients in whom there is a history of violent acts, predictions of future violence will be wrong for two out of every three patients." So concludes the American Psychiatric Association Statement on Dangerousness[1].

PRACTICE POINT

Assessment of Dangerousness remains an inexact science

Can a psychiatrist or psychologist reasonably be held responsible for the suicide of a patient? Recent clinical research[2] suggests that for risk of violence in a newly hospitalised patient, clinical judgment can be considerably more accurate, and that certain characteristics, for instance male or nonwhite, distort the appraisal in a predictable way.

Assessment of risk of suicide is a daily activity of emergency psychiatric services. Despite a lack of precision in forecasting, a number of authors[3], [4], [5], [6] have summarised the principal variables. If the various risk factors have not been quantified, or are inadequately documented or addressed, care-givers may be held liable for early suicide.

PRACTICE POINT

Components of adequate suicide risk assessment:
1. history of suicide
2. patient’s statements of intent
3. definiteness of plan
4. available means
5. substance abuse
6. psychopathology
7. hopelessness
8. third party confirmation
9. rationale of treatment plan

Unconsented third party involvement in the decision-making process presents considerable legal difficulty but may be required for a competent assessment of risk. A physician or psychologist who fails to make the reality check when appropriate may be found to have contravened community standards.