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1. General Issues Specific to Suicide

  • It is crucial for the suicide risk assessment to be documented in the medical record.

  • See Table 7 for general risk management considerations.

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Table Reference Number
TABLE 7. General Risk Management and Documentation Considerations in the Assessment and Management of Patients at Risk for Suicide
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2. Suicide Prevention Contracts

  • Reliance on a suicide prevention contract may falsely lower clinical vigilance without altering the patient's suicidal state.

  • If a suicide prevention contract is used, a patient's unwillingness to commit to the contract mandates reassessment of the therapeutic alliance and the patient's level of suicide risk.

  • Suicide prevention contracts are not recommended in emergency settings; with newly admitted and unknown inpatients; with agitated, psychotic, or impulsive patients; or when the patient is under the influence of an intoxicating substance.

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3. Communication With Significant Others

  • If a patient is (or is likely to become) dangerous to him- or herself or to others and will not consent to interventions intended to reduce those risks, the psychiatrist is justified in attenuating confidentiality to the extent needed to address the safety of the patient and others.

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4. Management of Suicide in One's Practice

  • If a patient dies by suicide, ensure that his or her records are complete.

  • Conversations with family members can be appropriate and can allay grief and assist devastated family members in obtaining help.

  • In speaking with survivors, care must be exercised not to reveal confidential information about the patient and not to make self-incriminating or self-exonerating statements.

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5. Mental Health Interventions for Surviving Family and Friends After a Suicide

  • Suggest psychiatric intervention to family members and friends shortly after the death to reduce their risk for psychiatric impairment.

  • Consider referring surviving family members and friends to a survivor support group.

Table Reference Number
TABLE 7. General Risk Management and Documentation Considerations in the Assessment and Management of Patients at Risk for Suicide

References

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