I love the title of J. Christopher Fowler’s article that was published in the current issue (vol 49, issue 1) of Psychotherapy, “Suicide Risk Assessment in Clinical Practice: Pragmatic Guidelines for Imperfect Assessments.” This practice review is thorough and wise. Fowler strikes just the balance between encouraging completeness and responsibility, and acknowledging the limits inherent in [...]
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Helping at-risk patients who rarely show up
January 4, 2011
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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 [...]
Read morePreparing my presentation for AAS 2010
March 18, 2010
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I’m preparing my presentation for the April 2010 American Association of Suicidology annual conference, which will be held in Orlando, Florida. My presentation is titled “Evaluation of Commitment to Living: a brief training to address suicide risk assessment and management.” I’m enjoying the preparations because I’m planning to present entirely using mindmaps on my curriculum which [...]
Read moreSpeaking 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 moreMeans restriction and impulsivity in fantastic NY Times piece
September 8, 2008
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I have mentioned quite a few NY Times articles in this blog because I think they cover suicide really well. Last month they published a piece in the NY Times Magazine that I keep recommending to people in informal and clinical discussions, so I thought I’d link to it here. Many thanks to my colleague [...]
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 morePossible contagion effect in Nantucket
March 18, 2008
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The small island of Nantucket, MA has seen 3 teen suicides in a short period of time, according to the New York Times. Very sad. Statistically, three suicides in a high school of 400 represents a meaningful cluster, and a possible contagion effect. Whether it is or it isn’t contagion in Nantucket (it [...]
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 moreNice article on risk assessment
September 28, 2007
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A colleague pointed me to a nice article on suicide risk assessment written by David J. Muzina, MD in the September issue of Current Psychiatry Online. The article is well-written and well-organized. The stepwise approach described can be quite helpful. I wish the article included more on documentation (there is only one sample note, and I’m not [...]
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