Having defended cases brought against our insured psychiatrists since the 1986, we know that patient suicide/attempted suicide is one of the top two allegations brought against psychiatrists in medical malpractice cases, the other being medication-related issues.

We also know that assessing for suicide risk is critical to understanding the patient’s condition and developing an adequate treatment plan. Moreover, in the event of subsequent litigation, contemporaneously documented risk assessments go a long way in showing that the psychiatrist met the standard of care.

And we unfortunately know that how to assess for suicidality is not well addressed in psychiatric training. With this educational gap in mind, PRMS was more than happy many years ago to fund the printing and distribution of the Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) card, originally conceived by Dr. Doug Jacobs, to the nation’s psychiatric residency programs.

Since that time, I’ve been very pleased to see that SAMSHA has taken over the SAFE-T card. And I just learned today that SAMSHA increased its distribution of the assessment tool via a new mobile app, Suicide Safe. According to the website (, this free app helps providers:

•  Learn how to use the SAFE-T approach when working with patients
•  Explore interactive sample case studies and see the SAFE-T in action through case scenarios and tips
•  Quickly access and share information, including crisis lines, fact sheets, educational opportunities, and treatment resources
•  Browse conversation starters that provide sample language and tips for talking with patients who may be in need of suicide intervention
•  Locate treatment options, filter by type and distance, and share locations and resources to provide timely referrals for patients.

While we’re on the topic of suicide risk assessment, here are my three top risk management points:

•  In many of our suicide cases, appropriate risk assessments were done, but not documented. To some degree, the old adage “if it wasn’t documented, it wasn’t done” applies and it becomes a “he said – she said” issue. Document the assessments!

•  In other cases, the initial assessment was done and documented well. But there were no additional assessments done. Assessing risk is not a one-and-done thing. There are many clinical junctures after the first contact that require additional assessment (for example, the SAFE-T card lists “with any subsequent suicidal thoughts, increased ideation, or other pertinent change; for inpatients, prior to increasing privileges and at discharge.”) We know that immediately after discharge can be a high risk period, so risk should be assessed as close to the time of discharge as possible.

•  We know from our cases as well as from patient safety literature that standardization in suicide risk assessment is beneficial. Having a framework ensures that important issues do not get overlooked. The SAFE-T card is one example of several assessment tools available. Find the tool that works best for you – and use it!

If you don’t already have an assessment tool that works for you, check out the Suicide Safe app now! Download the free app now from google play or apple’s app store.

Donna Vanderpool, MBA, JD – Vice President
As Vice President of Risk Management, Ms. Vanderpool is responsible for the development and implementation of PRMS’s risk management services for The Psychiatrists’ Program. Ms. Vanderpool has developed expertise in the areas of HIPAA and forensic practice, and has consulted, written and spoken nationally on these and other healthcare law and risk management topics. She most recently wrote a chapter concerning the risks of harm to forensic experts for Robert L. Sadoff, MD’s book Ethical Issues in Forensic Psychiatry: Minimizing Harm, (Feb. 2011/Wiley). Ms. Vanderpool received her undergraduate degree from James Madison University, and her MBA and JD from George Mason University. Prior to joining PRMS in 2000, Ms. Vanderpool practiced criminal defense law, taught business and legal courses as an adjunct faculty member at a community college and spent eight years managing a general surgical practice in Virginia.

This blog has also been cross-posted on LinkedIn.

Categories: PRMS Blog, Suicide