Should Mental Health Professionals Be the “Suicide Police”?
Suicide is an absolutely horrible phenomenon. It destroys families and forever leaves survivors on an elusive search for why it happened. Suicide is often viewed as a very selfish act, yet I believe that in many cases those who do it truly cannot endure the emotional pain any longer and believe that they are out of options. When I was a young adult, an extended family member committed suicide. During my career I have lost a small number of patients to suicide as well. These were all very tragic experiences.
In the United States, mental health professionals have a legal responsibility to take action when our patients appear to be at risk for harming themselves. It is not possible for us to accurately predict when a person is going to commit suicide, but we are expected to assess for and document suicide risk factors. If necessary, we may have to call police or take other action to have patients involuntarily admitted to an inpatient psychiatric unit.
Involuntary commitment is a very controversial topic. What usually does not get discussed, though, is the fact that many mental health professionals, including myself, are often very uncomfortable being placed in the role of essentially being responsible for someone else’s behavior.
Although the majority of people who attempt or commit suicide suffer from mental illness, some do not. For those who do, some may be psychotic and therefore completely out of touch with reality or so clinically depressed that they have lost all hope.
In the latter two examples, the patients likely have treatable conditions, and once treated, they may change their minds about wanting to die. Even when I believe a patient simply wants to die and has “legitimate” reasons for feeling this way, I always try to dissuade them from harming themselves. I have not, and will never, shirk my professional duties.
From a philosophic standpoint, it makes perfect sense to me that mental health professionals should do all that we can to help people however we can. What I find rather odd, though, is that people in our culture do not have a right under any circumstances to end their own lives. I am not in favor of physician-assisted suicide or suicide at all for that matter. But, on a human-to-human level, who the heck am I, anyway, to tell someone that they can’t end it all if they choose to? I’ve never been suicidal, but likewise, who is anyone else to tell me I cannot do it either?
I understand firsthand that if affects people other than the one doing it, but at some level, at least, isn’t that personal choice? And, if it isn’t, then who, if anyone, should be held responsible if someone chooses to end his or her own life – psychiatrists, psychologists, therapists, primary care physicians, family, friends? In various life situations, Western society is great at assigning blame when there is a bad outcome, but I rarely hear people talk about free will.
I’m really curious what people think about this issue. I don’t hear it discussed often, but I believe it should be.
First, I question your statement about “legal responsibility”. I think Tarasoff statutes only lay out a duty to protect others. Also, the courts would likely claim that psychiatrists are not responsible, just that we may incur liability for not having met the standard of care when that failure, in the opinion of an expert, led directly to the suicide. Maybe clinicians just figure the best way to stay out of trouble is to prevent the suicide. So we take responsibility.
It’s not just that we should not (cannot?) be responsible for the conduct of another person, but this myth of responsibility has damaged or profession. For example, I try to screen out patients who may be at risk, making it harder for them to find good treatment. And if a patient, new or existing, is in my practice, I feel stuck with them. If I discharge them, and they suicide, it looks like I caused it.
And yet, not only can we not predict suicide, but in my state at least we do not have power to hospitalize involuntarily. Even if we could, Marsha Linehan, PhD, last time I heard her, makes a pretty good case that no intervention, short of a straight jacket, does more than delay the act. Then there’s the fact that when a patient does appear to be at risk, we tend to devote considerable time and energy to saving them, with little likelihood of fair compensation.
Our role is to treat mental illness, not to control behavior. We need more expert witnesses who are willing to opine that the causality element does not apply in most cases, and fewer experts like Robert Simon who, in a recent article in JAAPL, even blames psychiatrists who are practicing defensively because of plaintiff’s verdicts, for patients suiciding.
Finally, I like that term, “suicide police.” Did you coin it?
Thanks for pointing that out about legal responsibility. I think you are technically correct. I was referring more to the liability issue (that feels to us like legal responsibility). Thanks for your comments. (I did come up with the “suicide police” term.)