CMPA RISK FACT SHEET

ACTION
FOR SAFE MEDICAL CARE

Psychiatry Patients at risk for suicide

Surveys suggest that more than half of psychiatrists have experienced a patient suicide.1 Although suicide is often
unpredictable, psychiatrists can take some measures to provide the best care for their patients who are at risk.

CONSIDER THIS
A middle-aged woman presents to the emergency
department (ED) worried that she will harm herself. The ED
physician wants to admit her to the psychiatry ward, but
because there are no beds available, she spends the night
in ED under a form 1. The following morning, the on-call
psychiatrist assesses the patient. She appears calm and is
asking to be discharged. She says she plans to take some
time off work to rest and visit relatives. The psychiatrist
believes the patient does not pose a threat to herself. He
discharges her after she agrees to follow-up with her family
physician and to return to the ED if she again has suicidal
thoughts. The following day, the patient commits suicide.
The patients family files a College complaint that alleges
the psychiatrist discharged her prematurely, and failed to
contact them for collateral information about the patients
history or advise them of the discharge. A peer assessor
is concerned about discrepancies between the record
of the patients stay in the ED and how she appeared to
the psychiatrist. For example, notes in the record made
the previous evening indicate that the patient displayed
paranoid ideation and was experiencing hallucinations,
but she displayed no such symptoms when the psychiatrist
personally assessed her. The assessor states that soliciting
information on the patients condition from her family or
probing more deeply into the reasons for the discrepancies
may have helped with the risk assessment. However, not
doing so did not violate the standard of care in this case.
The College counsels the psychiatrist to consider collecting
collateral information in similar cases.

WHAT DOES THIS MEAN FOR CMPA MEMBERS?

Suicides are devastating for all those close to the patients,
including the healthcare providers caring for them. It is also one
of the most common clinical situations leading to a medico-legal
case against a psychiatrist. Thorough documentation of the
patient encounter is critical.

FACT

SUICIDE is a leading cause of death for Canadian men

and women.2

FACT

10% of CMPA legal and medical regulatory authority

(College) cases involving a psychiatrist are related to
paent suicide.

FACT

The most common reason for a complaint in CMPA cases

involving paent suicide is DEFICIENT RISK ASSESSMENT.

FACT

ABOUT ONE-THIRD of paents in CMPA cases involving

suicide have a documented history of self-harm or a
previous suicide aempt.

Examples of recurring issues in cases involving patient suicide

not obtaining collateral information,
when necessary
not conducting an adequate risk
assessment or not documenting
theriskassessment
not appreciating the patients
emotionalstate
communication issues between
healthcare providers
inadequate supervision
inadequate hospital or institution safety protocols
unsafe physical environments

Continued
A14-004-E CMPA 2014

Continued

ACTION FOR SAFE MEDICAL CARE Psychiatry Patients at risk for suicide
RISK REDUCTION REMINDERS
It is widely recognized that suicide may be unpredictable
and that appropriate care may not prevent an
unfortunate outcome. The following points can assist
physicians in managing the risks:
1. Conduct a thorough assessment of the patients risk
forsuicide based on all available information.
2. Consider the need to seek out collateral information
from the patients family, when appropriate and
permitted by privacy legislation.
3. Ensure that documentation reflects your assessment
of the patients condition, including the risk of suicide,
and supports the diagnosis and the rationale for the
treatment plan.
4. When reinstating a patients privileges, adjusting
medications, or discharging a patient, document the
decisions in the patients record.

LEARN MORE BY ACCESSING THESE RESOURCES

Articles
Examining risk in psychiatric practice
Foreseeability: What is expected of a physician?
Physician interactions with police

1. Ruskin R, Sakinofsky I, Bagby RM, Dickens S, Sousa G. Impact of

patient suicide on psychiatrists and psychiatric trainees, Academic
Psychiatry (2004) Vol.28, p.104-10
2. Statistics Canada. Leading causes of death, by sex (both sexes),
January 2014. Accessed March 20, 2014 from: http://www.statcan.
gc.ca/tables-tableaux/sum-som/l01/cst01/hlth36a-eng.htm

Tel: 613-725-2000, 1-800-267-6522 cmpa-acpm.ca

3R1300-001-E CMPA 2013

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to
provide specific professional medical or legal advice, nor to constitute a standard of care for Canadian healthcare professionals.
The use of CMPA learning resources is subject to the foregoing as well as the CMPAs Terms of Use.