Suicide Prevention

John Fisher
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Stopping Medical Injustice

Suicide is Preventable

Suicide is one of the leading causes of death among persons under the age of 35.  Almost all suicides  involve persons with a past medical history of significant psychiatric illness, such as major depression or bipolar disorder, and many involve persons who had previous suicide attempts, substance abuse and significant warning signs such as marital problems or custody disputes.

Medical malpractice occurs in suicide prevention cases when the physician or nurse fails to recognize that a patient presents with imminent risk of harm and fails to provide treatment consisting in most cases of an involuntary hospital admission.

Why The Suicide Risk Assessment is Critical in a Malpractice Case

The initial question in a case involving a suicide is whether an adequate suicide risk assessment was performed.  A suicide risk assessment will usually contain check boxes that are completed by the psychiatric nurse or psychiatrist concerning different areas of stress and emotional crisis.  The suicide risk assessment will address the patient's risk of suicide by inquiring about custody and marital disputes, chronic health issues (i.e., cancer), substance abuse and a past history of suicide attempt and psychiatric illness.

The biggest risk factor on a suicide risk assessment is a past history of suicide attempt.  If a person has a history of a recent suicide attempt (within the last year or so), he/she is at particularly high risk for suicide.  Certain psychiatric conditions, such as major depression and bipolar disorder, significantly increase a person's risk of suicide when faced with an emotional crisis.

Substance abuse with drugs or alcohol significantly increase a person's risk of suicide.  Judgment is impaired by alcohol and drug abuse and this alone increases a person's decision-making abilities when faced with an emotional crisis. Marital and custody problems also increase the risk of suicide by increasing the stress, anxiety and hopelessness in the patient's life.

Although females attempt suicide four to five times the rate of males, they tend to choose less lethal means of suicide, i.e., overdosing on pills.  Men, on the other hand, are much more successful at suicide than females and the rate of suicide among men is four to five times the rate for females.  Male gender alone is a risk factor for suicide.

When assessing a patient's risk of suicide, the psychiatrist or nurse should gather information from collateral sources, such as family members, police or clinicians.  The patient's family members know the patient best and can provide critical information about the patient's risk of suicide that the patient refuses to volunteer.  Suicide malpractice cases often focus on the failure of the doctor or nurse to get collateral information about the patient's risk fo suicide.

 Treatment for Patients at Risk of Suicide

Once the psychiatrist or hospital has completed the suicide risk assessment, it should have written procedures that provide for the interventions and treatment for those at moderate to high risk of suicide. 

In New York, a physician can involuntarily commit a patient for 15 days to a hospital when the patient is considered to be at imminent risk of suicide.  The 15-day period for an involuntary hospital admission can be extended.  Involuntary admission to a hospital often provides the patient with medical management and counseling to overcome the emotional crisis in his/her life.

The Most Common Mistake Made in Suicide Prevention Cases

The most common mistake made by psychiatrists and psychiatric nurses is reliance upon a suicide prevention contract, a/k/a a "safety contract".  The suicide prevention contract asks the patient to "contract for safety"--i.e., he/she signs a document stating that they will not hurt or kill themselves.  When a person wants to commit suicide, they will sign the suicide prevention contract in order to avoid an involuntary admission to the hospital.  Psychiatrists and psychiatric nurses should never rely on a suicide prevention contract in assessing a patient's risk of suicide.

Studies have shown that 78% of patients who commit suicide in a hospital signed a suicide prevention contract and/or denied that they intended to harm or kill themselves.  Yet in malpractice cases psychiatrists and nurses place heavy reliance no suicide prevention contracts in defending the case.  Reliance on a suicide prevention contract by a psychiatrist or nurse is a weak defense in a malpractice case arising from a suicide.

The Most Common Myth about Suicide Malpractice Cases

A common myth about suicide malpractice cases is that the patient's death was inevitable even with proper medical management and counseling.  In 1978, a psychology professor, Richard Seiden, Ph.D., authored a retrospective study of persons who were prevented from jumping off the Golden Gate Bridge in San Francisco.  Professor Seiden examined the lives of the survivors of suicide attempts over a 25-year period (only 1% of persons survive a jump off the Golden Gate Bridge, but many suicides are prevented when persons are contemplating jumping) and he discovered that 94% of these persons did not commit suicide or harm themselves.  In fact, 94% of suicide attempters went on to live fairly normal lives.

Professor Seiden's report entitled, "Where are they now?", revealed that suicide attempts occur at a time of extreme emotional crisis that are temporary; if the suicide is prevented, more than 90% of those attempting suicide will not take their lives.  This study dispels a common perception that suicide is inevitable for those persons who want to end their life.

The Critical Questions in a Case Review involving a Suicide

The first question is whether a valid suicide risk assessment was performed. In malpractice cases, the suicide risk assessment is either inadequate or based on incomplete information.  For patients presenting at moderate to high risk of suicide, the doctor and/or nurse should made every attempt to gather collateral information from the patient's family members, police and/or mental health provider.

If the patient was deemed to be at imminent risk fo suicide or should have been classified as imminent risk of suicide, the second question is whether the doctor, nurse or hospital took adequate interventions to prevent a suicide.  Medical interventions to prevent a suicide typically consist of an involuntary admission to the psychiatric ward of a hospital, where the patient will be given medical management and counseling.  The attending physicians at the hospital should consult with the patient's treating mental health and primary care physicians to corroborate the information provided by the patient.

What Damages are Recoverable in a Suicide Malpractice Case?

The damages in a suicide malpractice case consist of the patient's pain and suffering from the suicide, but more importantly, the loss of a parent to the victim's children and the loss of earnings to a surviving spouse. The loss of a father or mother for children is a very substantial loss in a suicide malpractice case.

How you can get more information about Suicide Prevention

If you would like more information or wish to discuss a potential suicide malpractice case, I welcome your phone call at 1-866-889-6882.  I offer a FREE e-book, The Seven Deadly Mistakes of Malpractice Victims, which you can download at the home page of our website,  We are here to help you!