From early on in my quest to understand the unique challenges mental health professionals face in working with patients at risk for suicide, I’ve wondered aloud about the things that make us the most nervous. I’m still working my way through a list of questions I posted based on my notes from a series of [...]
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Speaking of nomenclature…what about “protective factors”?
October 23, 2008
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Speaking of nomenclature, I’m increasingly growing mistrustful of the term “protective factors.” It sounds very “evidence-based” to refer to “risk and protective factors” when discussing one’s approach to risk assessment. However, I’ve noticed a subtle misunderstanding that has creeped in along with the popularity of these terms. Often, it sounds like some clinicians are thinking [...]
Read moreA better term for “high risk”?
October 22, 2008
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At a recent workshop I presented, a senior colleague commented that our clinical vernacular needs a more apt phrase than “high risk” to describe individuals whose clinical and historical presentation suggests risk for suicide. “High risk for suicide,” he pointed out, sounds like suicide is probable, when in fact the likelihood of suicide in [...]
Read more“Trusting” a person at risk who agrees to transport self
September 2, 2008
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A colleague forwarded me the following excellent question posted to a listserv: One question that has been raised is how to handle an individual who reports willingness to voluntarily go to the ER for psychiatric assessment. Since trusting a questionably unstable and suicidal individual to present for treatment opens our agency and the patient up [...]
Read moreTeaching and learning at New York State psychiatric facilities
April 28, 2008
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I’ve returned from a fascinating series of trips to two New York State psychiatric facilities (St. Lawrence Psychiatric and Pilgrim Psychiatric), as part of a project I’m working on with the Office of Mental Health. I learned a great deal from talking about suicide risk with over 500 clinicians from a variety of disciplines and [...]
Read moreIrreverant documentation post
October 12, 2007
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I came across this irreverent, but pretty informative post by the Last Psychiatrist about documentation for patients with suicidal thoughts or behavior. He is writing from the perspective of an acute services physician, but much of what he says applies across settings. Note that the post has ads embedded in it. Besides being annoying, the [...]
Read moreReflecting on Intersections with Knowledge Management, Dave Snowden, and Singapore’s Risk Assessment and Horizon Scanning System
April 3, 2007
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Warning: This post starts out a bit far afield from clinical work. My ideas about how it ultimately connect back, but they’re still forming, so this is definitely a “put on your seatbelt” kind of post. For some time, I have been following the work and blog of Dave Snowden, founder of Cognitive Edge. Snowden [...]
Read moreGender, race, and culture in risk formulations
March 14, 2007
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I’m trying to think about how to categorize risk factors related to gender, race, culture when presenting about risk and guiding people to make risk formulations. In my initial concept maps, I included “male gender” as one of the “predisposition” factors, following categories offered by Bryan & Rudd (2006). But then when I saw how [...]
Read moreStandardizing Risk Assessment Documentation
January 30, 2007
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There are no established formats for documenting a formulation of suicide risk. I have taken some steps to standardize this documentation in the clinical service I direct, but it needs further development. I’ll be helping our department arrive at a common format. Thankfully, I’ll be working with some really bright people who can view this [...]
Read moreHow we think about Primary Care “Gatekeepers”
January 27, 2007
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Primary care physicians are often grouped in as “gatekeepers,” who need to be able to ask about suicide, know warning signs, and refer. The tend not to get in-depth training about formulating or documenting risk assessments. The problem with this “gatekeeper” view is that we don’t have the kind of seamless system that allows the [...]
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