Managing Liability Risk When Treating Suicidal and/or Violent Patients

Recent episodes of mass violence and high profile suicides have renewed the national conversation concerning the connection between mental illness, and suicide and violence. 

Despite well-documented evidence illustrating the difficulty in predicting suicide and violence, society holds behavioral health providers responsible for safeguarding patients from self-harm and the public from violence. When treating potentially suicidal/violent patients, the behavioral health provider’s liability risk may be reduced by thoroughly assessing and documenting an individual’s risk of harm to self or others.

In malpractice actions involving suicide and/or violence, negligence claims tend to center on the behavioral health provider’s failure to diagnose/treat the patient’s suicidal/homicidal ideation. In these cases, courts generally focus on two issues: foreseeability and causation. 

Specifically, courts consider whether the patient’s actions could have been predicted and whether the provider did enough to avoid the resulting harm. The thoroughness of the assessment, and related documentation, often become the central issues in these malpractice actions. 

Conduct a Risk Assessment of Patients

Thorough risk assessments are crucial when treating potentially suicidal/violent patients and should be completed not only at the onset of treatment, but also at every critical juncture in care, including but not limited to: Changes in medical condition; changes in observation status; upon discharge from hospitalization/resumption of care; and with the occurrence of significant life events. Additionally, the results of each completed assessment should be communicated to all treatment providers, after obtaining proper consent.

Although not an exhaustive list, a thorough risk assessment will include areas pertaining to:  Patient history (including a review of prior assessments and medical records); past suicide attempts; prior violent acts; presence of risk factors; history of substance abuse; and weapons ownership/access. 

When assessing potentially violent actions by the patient against a third party, the assessment should also include questions and follow up regarding: Any specific threats made by the patient; the identity of potential victims; and the patient’s ability to follow through with the threat (do they have a plan, method and/or means to complete the act). In these situations, it is important that the provider understand his/her individual state’s duty to warn obligations. Duty to warn obligations vary among the states (and often professions) and it is a good idea to consult with your liability insurer’s risk manager or an attorney.