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Therapeutic Risk Management of the Suicidal Patient: Stratifying Risk in Terms of Severity and Temporality


Journal of Psychiatric Practice: January 2014 - Volume 20 - Issue 1 - p 63–67
doi: 10.1097/01.pra.0000442940.46328.63
COLUMNS: Law and Psychiatry

This column is the third in a series describing a model for therapeutic risk management of the suicidal patient. In the preceding column, we described augmenting clinical suicide risk assessment with structured instruments. In this column, we describe how clinicians can use the totality of available clinical data to offer a two-dimensional risk stratification that qualifies risk in terms of both severity and temporality. By offering two separate designations that reflect severity for both acute and chronic risk, conceptualizing and communicating a patient’s risk for suicide is accomplished in a more nuanced way, providing the level of detail necessary when working with high risk individuals, especially those struggling with chronic suicidal ideation. Formulations reflecting suicide risk need to be accurate and facilitate good clinical decision-making in order to optimally balance the principles of autonomy, non-maleficence, and beneficence. Stratifying risk in terms of both severity and temporality helps identify situations in which involuntary hospitalization is warranted, while also helping to minimize unnecessary admissions. Hence, two-dimensional risk stratification that addresses both acute and chronic risk for suicide is an essential component of therapeutic risk management of the suicidal patient. (Journal of Psychiatric Practice 2014;20:63–67)

Hal S. Wortzel, MD, is the Michael K. Cooper Professor of Neurocognitive Disease, Director of Neuropsychiatry, an Assistant Professor in Psychiatry and Neurology, and Faculty for the Forensic Psychiatry Fellowship at the University of Colorado. He is Director of Neuropsychiatric Services for the VISN 19

Mental Illness Research, Education and Clinical Center (MIRECC) at the Denver VA. Dr. Matarazzo is Co-Director of the VISN 19 MIRECC Suicide Consultation Service and a Clinical Research Psychologist, VISN 19 MIRECC, Denver VA, and Assistant Professor of Psychiatry, University of Colorado. Dr. Homaifar is Assistant Training Director for the Post-Doctoral Fellowship and Co-director of the VA Suicide Risk Management Consultation Program, VISN 19 MIRECC, Denver VA, and Assistant Professor of Psychiatry, University of Colorado. Dr. Brenner is Director of the VISN 19 MIRECC and Associate Professor of Psychiatry, Neurology, and Physical Medicine & Rehabilitation, University of Colorado, Anschutz Medical Campus. Address inquiries to:

© 2014 by Lippincott Williams & Wilkins, Inc.