Comments on: Should Mental Health Professionals Be the “Suicide Police”? http://lockupdoc.com/2009/11/should-mental-health-professionals-be-the-suicide-police/ Correctional Psychiatry Blog Fri, 12 Mar 2010 02:09:32 +0000 http://wordpress.org/?v=2.9.2 hourly 1 By: Lockup Doc http://lockupdoc.com/2009/11/should-mental-health-professionals-be-the-suicide-police/comment-page-1/#comment-4 Lockup Doc Fri, 13 Nov 2009 03:40:15 +0000 http://lockupdoc.com/?p=69#comment-4 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.) 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.)

]]> By: moviedoc http://lockupdoc.com/2009/11/should-mental-health-professionals-be-the-suicide-police/comment-page-1/#comment-3 moviedoc Fri, 13 Nov 2009 02:31:40 +0000 http://lockupdoc.com/?p=69#comment-3 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? 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?

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