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A Model for Therapeutic Risk Management of the Suicidal Patient


Journal of Psychiatric Practice®: July 2013 - Volume 19 - Issue 4 - p 323–326
doi: 10.1097/01.pra.0000432603.99211.e8
COLUMNS: Law and Psychiatry

While the practice of psychiatry involves many challenges, few scenarios are as clinically and emotionally demanding as managing the patient who is at high risk for suicide. Risk management is a reality of psychiatric practice, and this necessitates practicing and documenting thoughtful suicide risk assessment and management. Therapeutic risk management is based on clinical risk management that is patient-centered, supportive of the treatment process, and maintains the therapeutic alliance. In this article, the authors present a broad overview of a model for achieving therapeutic risk management of the suicidal patient that involves augmenting clinical risk assessment with structured instruments, stratifying risk in terms of both severity and temporality, and developing and documenting a safety plan. These elements are readily accessible to and deployable by mental health clinicians in most disciplines and treatment settings, and they collectively yield a suicide risk assessment and management process (and attendant documentation) that should withstand the scrutiny that often occurs in the wake of a patient suicide or suicide attempt. (Journal of Psychiatric Practice 2013;19:323–326)

Hal S. Wortzel, MD, is the Michael K. Cooper Professor of Neuro- cognitive 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 at the Denver VA. Bridget Matarazzo, PsyD, is Co-Director of the VISN 19 MIRECC Suicide Consultation Service, VISN 19 MIRECC, Denver VA, and Assistant Professor of Psychiatry, University of Colorado. Beeta Homaifar, PhD, 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. Address inquiries to:

© 2013 by Lippincott Williams & Wilkins, Inc.