Crisis Intervention in the Context of Outpatient Treatment of Suicidal Patients (IN: Assessment, Treatment, and Prevention of Suicidal Behavior, edited by R I Yufit & D Lester)

This chapter outlines a framework for crisis intervention in suicide management that is guided by a basic conceptualizaton of suicide that incorporates crisis intervention principles & goals. Additional variables that are critical to clinically sound outpatient management of suicidal patients & issues that tend to be underemphasized by therapists in working with suicidal patients are […]

Improving the Quality of Suicide Risk Assessments in the Psychiatric Emergency Setting: Physician Documentation of Process Indicators

The quality of suicide risk assessments in the psychiatric emergency setting was evaluated by reviewing physician documentation of process indicators. Medical records of 145 patients involuntarily admitted were reviewed for 19 process indicators. Documentation that a process indicator was not met by a patient was included in the data. Patients were divided into 2 groups: […]

Suicide in Correctional Settings: Assessment, Prevention, and Professional Liability

This article reviews the suicide risk assessment procedure as it pertains to incarcerated individuals. Research on correctional suicide risk factors is briefly outlined as a prelude to discussing current methods of clinical suicide risk assessment & prevention in correctional settings. A comprehensive & reliable procedure for eliciting suicide ideation, behaviour, planning, desire, & intent is […]

Adolesents who Self-Harm: how to Protect Them From Themselves

When treating teenagers with self-harming thoughts & behaviour, it may be difficult to distinguish suicide attempts from self-injury without intent to die. Understanding adolescent self-harm, suicide risk assessment, & treatment options guides clinicians to appropriate interventions. Recognizing the need for aggressive treatment – including psychiatric hospitalization – is essential to keeping self-harming teenagers safe. (28 […]

Using Civil law Occupational Death Procedures in Police Suicide Reporting (In: Suicide and Law Enforcement, edited by D C Sheehan & J I Warren)

Both state & federal civil law require mandatory procedures in the event of occupational death. Any deviation from these procedures can result in civil monetary penalties & criminal charges. Statutory law & recent case law provide the legal foundation for development of mandatory police suicide reporting procedures. Using the occupational death reporting procedures outlined by […]

The Utility and Effectiveness of 15-Minute Checks in Inpatient Settings

Implementing harm reduction is among the administrative tasks used for maintaining a safe unit for psychiatric inpatients. Included in nursing procedures for observing suicidal patients is the practice of 15-minute checks. In reviewing the standard forms used in several major hospitals across the United States, the authors noticed a wide variation in the format & […]

Suicide Decline in Australia: Where did the Cases go?


Identifying Deliberate Self-Harm in Emergency Department Data

Emergency department data may underestimate deliberate self-harm if some records that are coded “undetermined” actually represent deliberate self-harm. Data from the National Ambulatory Care Reporting System were utilized. A total of 24,437 Ontario emergency department records for 2001/2002 coded deliberate self-harm or undetermined were analyzed. For every two emergency department presentations coded deliberate self-harm, another […]

A Resource Guide for Implementing the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 2007 Patient Safety Goals on Suicide Featuring the Suicide Assessment Five-Step Evaluation and Triage (SAFE-T)

This document serves as a resource guide, using the Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) protocol to facilitate implementation of patient safety goals on suicide. The model involves identifying risk factors; identifying protective factors; asking about suicide thoughts, plans, behaviours, & intent; determining level of risk & choosing appropriate interventions; & documenting the assessment […]

Documentation of Suicide Risk Assessment in Clinical Records


Suicide in the National Protocol for Monitoring Sentinel Events

This study describes sentinel events reported to the Italian Ministry of Welfare in the first 18 months of activity. 123 reports were received, suicide being the most reported event. The analysis of the causes & contributing factors has highlighted the lack of application, & sometimes the total absence of appropriate procedures & guidelines which would […]

Northwest Suicide Prevention Tribal Action Plan: a Five-Year Strategic Plan for the Tribes of Idaho, Oregon and Washington 2009-2013

This document outlines a strategy to reduce suicide rates among American Indians & Alaska Natives living in the Pacific Northwest by increasing tribal capacity & improving collaboration. The primary goals of the plan are to: increase knowledge & awareness about suicide & in doing so take steps to address the stigma that exists in many […]

Effects of Training on Suicide Risk Assessment

45 psychiatry & psychology trainees participated in a workshop on evidence-based risk assessment. A comparison group of 10 psychiatry trainees participated in a different workshop on the application of evidence-based medicine to psychiatry that was not focused specifically on risk assessment. Before & after each workshop, participants rated their skills in assessing patients’ risk of […]

A Call for Action: Building Consensus for a National Action Plan on Mental Illness and Mental Health

Reprint of the 2000 publication.

The Effectiveness of a Deliberate Self Harm Service

The psychiatric service provided for the assessment of Welsh patients admitted to a district general hospital following deliberate self-harm was evaluated. The service was modified as a result of the findings. A re-evaluation was done one year later to measure the effectiveness of the changes that were made. (14 refs.)

Better Data Gathering to Prevent Suicide

The author of this article asserts better data gathering can help not only identify those at risk of suicide more effectively but also connect these individuals with the necessary preventive services. The National Violent Death Reporting System in the United States is discussed as a program that can be used to develop effective prevention policies […]

Liability When Patients die After Treatment: how to Manage Requests for Pain Medication and Post-Discharge Suicide Risks

This article briefly discusses judicial rulings in two American cases where psychiatric patients died after treatment. In one case, the patient’s estate claimed the psychiatrist was negligent in discharging the patient from hospital without a post-discharge recovery plan. However, it was shown that such a plan was in place & the jury found for the […]

Writing Progress Notes: 10 Dos and Don’ts. What to Include in – and Exclude From – Patients’ Medical Records

This article provides a summary of what information psychiatrists should include in a patients’ progress notes. Psychiatrists are advised to be concise but to include details that explain treatment decisions such as discontinuing suicide precautions or not hospitalizing the outpatient who expresses suicide ideation. Psychiatrists should also provide sufficient detail for other caregivers who will […]

Practice, not Malpractice. 3 Clinical Habits to Reduce Liability Risk

This article offers general recommendations – not legal advice – based on court decisions & other evidence for managing traditional risks such as patient violence, suicide, adverse drug reactions, sex with patients, faulty termination of treatment, & supervisory & consultative relationships. Newer risks such as recovered memories, off-label prescribing, practice guidelines, & e-mail & confidentiality […]

Reducing Suicides in Barking & Dagenham: Audit of Suicide and Strategy Public Health Report No: Dph 210

This document provides an audit of suicide & deliberate self-harm in Barking & Dagenham, a borough of London. While the suicide rate has been reduced, current projections indicate the 2010 target rate of 4.3 per 100,000 will not be met. Recommendations are made for key actions in primary & secondary care, social care, & community […]

Surveillance for Violent Deaths – National Violent Death Reporting System, 16 States, 2005

The 16 states included in the study are Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, Virginia, Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, Wisconsin, Kentucky, New Mexico, & Utah.

Suicide Prevention Down Range: a Program Assessment

This article notes there have been 72 confirmed suicides by American soldiers since the beginning of the war with Iraq. The procedures for collecting this data are described, including inclusion criteria. The majority of deaths involved single, white, male, junior enlisted soldiers, with the cause of death being a self-inflicted gunshot wound. This profile is […]

Assessing and Managing Suicide Risk: Guidelines for Clinically Based Risk Management