is endangering him- or herself or a third party as a result of psychiatric illness. See the Resources section for a link where practitioners may access their state’s statutes. Once clinicians have a good working knowledge of the state laws that govern involuntary commitment, they still are faced with the difficult decision of when to recommend this step for patients who are seriously at risk for engaging in self-harm. Unfortunately, there is no concrete, universally- accepted definition of “imminent risk” for suicide. Suicide risk likely varies from minute to minute, hour to hour, day to day (Kleiman et
al., 2017). This makes any prediction about imminent suicide, in Simon’s words, “illusory.” Moreover, time attenuates the accuracy of suicide assessments that are “here-and-now” judgments. Therefore, suicide assessment must be a process, not an event (Sommers-Flanagan & Shaw, 2017). Outpatient settings are not an appropriate level of care for patients who express a clear imminent intent and acknowledge possession of means to kill themselves. If such patients are unwilling to voluntarily admit themselves to an inpatient setting, they do meet the criteria for commitment to a secure inpatient hospital setting.
ONGOING DOCUMENTATION OF SUICIDE RISK IN CLINICAL PRACTICE
Although the basics of suicide risk assessment documentation have already been covered, there are a number of additional aspects of documentation to consider when working in clinical settings. Clinicians are always responsible for doing what is reasonably possible to enhance patient safety and care, and the areas of patient self-harm and suicidality are especially important for clinicians to address through risk assessment and risk management (Obegi, 2017). When beginning with a patient who has a history of suicidal ideation, attempts and self-injurious behavior, it is crucial to document all of the components of risk assessment and rationale to inform decision-making (Crowe, 2018). Crowe advises: Standard 10: Record keeping and confidentiality Social workers practicing in healthcare settings are expected to maintain timely documentation that includes pertinent information regarding patient assessment, intervention and outcomes, and must work to safeguard the privacy and confidentiality of patient information. Interpretation (NASW, 2016): Clear, concise and ongoing documentation of social work services in health-care settings facilitates effective communication with other health-care providers and organizations, thereby promoting continuity of services. Documentation serves as a foundation for care planning and for practice and program evaluation. In addition, professional documentation is often required for services reimbursement, utilization or legal review, and demonstration of organizational accountability to payers or funding sources. The purpose of documentation is to foster strong working relationships with, and services for, patients in healthcare settings. Documentation of social work services should be recorded on paper or electronically and must be prepared, secured, and disclosed in accordance with regulatory, legislative, statutory and organizational requirements. ● Initial and subsequent biopsychosocial-spiritual assessments. ● A patient care plan, with procedures for monitoring and quantifying progress toward accomplishment of patient goals, services provided, and other information about plan implementation. ● Referrals to or from other practitioners, organizations or resources, including rationale for referrals, and other collaboration on behalf of the patient. Acute suicide emergency intervention Patients seen in an emergency room setting must be immediately referred to a psychiatrist, psychologist, or other qualified healthcare provider. Clinicians should also use the assistance of law enforcement and emergency-response personnel, when needed, in outpatient cases that necessitate immediate transportation to a medical facility for evaluation. In all states, law enforcement has the right to place individuals into protective custody when there is suspicion that they may be a danger to themselves or others. High-quality documentation includes: ● The patient’s identifying information. ● Screening results.
Documentation of suicide risk should state more than, “Patient denied suicidal ideation at this time.” It is also important to document the safety plan that is created with the patient and/ or in consultation with colleagues/supervisors in addition to the typical information included in the patient documentation form. Increased face-to-face and phone contact is recommended during times that the patient is experiencing, or signaling, suicidal ideation in order to continue to assess whether the patient needs additional care at a hospital. Following up with the patient is crucial in the prevention process (p. X). ● Dates, times, and descriptions of contact with the patient, the patient’s support system, and other healthcare providers or organizations. ● Quantifiable service outcomes. ● Supervision or consultation sought or provided to enhance social work services. ● Transfer or termination of services. ● When indicated, written permission from the patient to release and obtain information. ● Documentation of compliance with confidentiality and privacy rights and responsibilities. ● Accounting of receipts and disbursements related to patient services provision. (NASW, 2016) Although patient care is the primary priority of clinicians, it is also important for clinicians to protect themselves professionally. Suicide is the most common cause of legal action against mental health care professionals (Jacobson, 2017). Documentation is the cornerstone of the defense in a potential suicide case. Good care combined with good documentation is the surest way to avoid being sued for malpractice. From the perspective of attorneys who review suicide-related matters for prospective plaintiffs on a weekly basis, the quality of documentation can determine whether a malpractice attorney accepts or declines a suicide case (Stanley et al., 2019). When assessing suicidal patients, consulting with knowledgeable colleagues not only helps the patient, but also adds to the clinician’s risk-management strategy. Documenting that this consultation occurred, as well as the issues considered, is a wise risk- management strategy (Obegi, 2017). Emergency response and emergency room staff should be appropriately trained to deal with suicidal patients. An empathetic approach is indispensable in these cases. Emergency room staff must be aware of any biases toward suicidal patients, including religious or philosophic beliefs, lack of formal psychiatric training, inadequate staff and short-staff departments. In an emergency setting, the challenge is identifying patients safe enough to go home. Some emergency departments have mental health professionals on call to help evaluate suicidal patients and determine those safe enough to go home (Kazim, 2017).
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Book Code: PYCA1423
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