Suicide prevention starts with the patient’s narrative
She stressed the importance of a therapist orienting a patient to the management style to expect, “so what you do is not a surprise.” The therapist should listen to the patient’s goals, and carefully review expectations and a step-by-step plan. If the patient identifies potential problems and limitations, Dr. Comtois suggested commiserating with the patient about difficulties but not justifying them. For example, reviewing with patients how likely you will be to answer their phone call, what would likely happen during and as a result of a call, and offer the patients your advice on what to do if you can’t answer their call.
Dr. Comtois acknowledged that some clinicians fear managing and treating a suicidal patient, and advised “getting past your fear to help the client find a path forward. If you can get past your fear” the intervention often boils down to “clinical common sense: Things you would know how to handle if suicide weren’t involved.” If clinicians feel they can’t help, she suggested learning new skills to make assistance possible, or referring the patient to someone else who could help. “Negligence is not making a wrong decision; it’s doing nothing. Liability risk is often a huge fear,” but if the clinician at least makes a consult, that reduces the risk of potential negligence. She warned against referring suicidal patients to a hospital emergency department. “In this day and age, the emergency department is not a source of treatment; it’s a gatekeeper.”
While published evidence documents the efficacy of dialectical behavior therapy and case management for preventing suicide and self-harm biological treatments, including antidepressants, lithium, and other psychopharmacology have not been effective, she said.
Dr. Comtois had no disclosures.
