What we’ve said about Suicide risk assessment

“the question is not a binary. It is not a question of, are they suicidal or not? Your job is not to predict the future. You cannot predict the future”

“What you're doing is you're saying, how dangerous is this driver, generally speaking, compared to the other person? And should we therefore insure them or raise their premium or not insure them”

“What you're doing is assessing their chronic risk, then based on their, on top of their chronic risk, their acute risk”

“even if there seems to be something rational, the fact that someone is in front of you as a psychiatrist means that the pretest probability is high, that they are not of the variety where it's purely rational”

“if you are overly fearful or anxious about talking about this topic and thinking about this topic and assessing this topic, you are going to consciously or unconsciously show this to the patient”

“You're looking at short term and long term for risk factors and protective factors. Sum them all up. Align that to your understanding of the variety of suicidal ideation or varieties that this patient has and the treatment options. Then decide on a treatment plan”

“So those five things are entrapment. So if a patient feels trapped or hopeless or that they're stuck in a situation, that to me is actually probably the most important thing that you can see in a patient”

“Irritable Being Really Activated That's Why Bipolar And Agitated Depressions Are The Most Dangerous In Terms Of Treatable Medical Conditions Towards Suicidality”

“any patient who evokes a strong pull to either rescue or over-involve yourself, or on the flip side, to detach and just give up on a patient. Those are the two things that he warns about”

“I would definitely just at least read the Columbia Suicide Severity Rating Scale. That's a pretty good scale, kind of a gold standard scale these days. It really does collect the history that you need. And remember, history is not the same as assessment”

“as a clinician, you should be comfortable, familiar with being the whiny five-year-old who won't stop asking why. Don't take it for granted already. Once she says, oh, I never sent it and I don't want you to talk to the boyfriend. Ask why”

“when the stakes are higher, when the symptoms are higher, yeah, we need to be gathering more information and getting more certainty when the stakes are higher and higher”

“So top of the differential usually is substances, personality, and mood disorders. OK, so now you're going to assess for those and you're going to you can't just assess responsibly when there is high dangerousness based on the output statements and behaviors on one look of a patient”

“when we disposition and we risk stratify cases like that, we're using case history. We don't need to opine on whether or not they have a personality disorder”

“the correct response to suicidality really depends on the patient. So here, as you're saying, is the best treatment for a patient that has what you're describing, which is an adjustment disorder, is hospitalization”

“if a patient is not at their normal level of risk based on your assessment, that is a sign to consider changing the treatment plan”

“if you see a change from the patient's clinical baseline, or if you don't know the patient's clinical baseline and their risk assessment is showing things like they won't contract for safety, they have been planning and preparing things”

“when it comes to discharge time, your job is not to predict the future. Your job is to do your job, which is to be practicing within the standard of care. And so you just have to do a risk assessment, right”

“What you're ultimately liable for isn't an outcome. It's a process. So what you need to be doing is that you need to be actually doing your assessment process within the standard of care and also documenting it”

“Clozapine is the only med that gets the FDA nod for suicidal reduction in schizophrenia. It also has... a little special benefit in violence reduction”

“the majority of completed suicides are not from patients presenting reporting suicidality. Okay, majority of people who complete suicide are actually people who've never even seen a psychiatrist and usually have never mentioned suicidality at all”

“if you do it blindly, you're doing cargo cult psychiatry, as I've in the early episodes had the tendency to refer to. We can't simply do the ritual. We have to understand where the ritual comes from and why it's done”

“it's actually really doing a lot of danger because it teaches patients that like if I want to get discharged in the hospital I just have to answer these questions the way I know they expect to be answered and then I'm done”

“I've seen a lot of novice providers go up to patients, especially like in the emergency room and go like, Any thoughts are hurting yourself or hurting other people. And the person obviously is going to get defensive and blocked down”

“in the emergency room, if a patient has 15 suicide attempts, it sounds like that they're super high risk, but it doesn't actually indicate anything about risk for the patient in front of you”

“patients with borderline personality disorder are at an elevated risk compared to patients without borderline personality disorder of completing suicide”

“There are patients who will genuinely believe that And it will be true at the time of the interview that they are not dangerous in some fashion. And then they will go kill themselves or hurt somebody else within 24 hours of release”

“I was consulted by a surgeon. to assess for suicidality in somebody who just went through some kind of a painful waking procedure and afterwards said something along the lines of, boy, if I have to go through that again, I'm going to kill myself”

“the majority of states will punish the doctor Okay, punish the doctor for being more lax rather than being more strict in terms of you will not go wrong for involuntary detainment and allowing a judge or judicial officer to release the patient”

“Asking about self-harm is standard. It should be standard in every single encounter with a patient”

“being transparent as to how you're thinking about the case can help the patient understand why you want the information. Not just that if he says you sent the text, then you're going to be locked away forever”

“being honest with a healthcare provider of any kind is key for you to actually get better”

“You should be advising patients about risk of suicidal ideation and agitation from SSRIs. Again, this is really primarily probably in bipolarity, but it is a risk”