Suicide Wrongful Death: Standard of Care Problems Involving the Inaccurate Discernment of Lethal Risk When Focusing on the Elicitation of Suicide Ideation

Authors: Bill D. Geis, Frederick Newman

Abstract:

Suicide and wrongful death forensic cases are the fastest rising tort in mental health law. Most suicide-related personal injury claims fall into the legal category of “wrongful death.” Though mental health experts may be called on to address a range of forensic questions in wrongful death cases, the central consultation that most experts provide is about the negligence element—specifically, the issue of whether the clinician met the clinical standard of care in assessing, treating, and managing the deceased person’s mental health care. Standards of care, varying from US state to state, are broad and address what a reasonable clinician might do in a similar circumstance. This fact leaves the issue of the suicide standard of care, in each case, up to forensic experts to put forth a reasoned estimate of what the standard of care should have been in the specific case under litigation. Because the general state guidelines for standard of care are broad, forensic experts are readily retained to provide scientific and clinical opinions about whether or not a clinician met the standard of care in their suicide assessment, treatment, and management of the case. In the past and in much of current practice, the assessment of suicide has centered on the elicitation of verbalized suicide ideation. But suicide ideation, in the matter of suicide risk determination, may be a necessary but insufficient target of lethal suicide risk assessment. Assessment of near-term suicide risk—assessment that goes beyond verbalized suicide ideation and relates to acute crisis variables—is likely needed. Specifically, such other or additional suicide risk variable assessment may be required in the context of lethal suicide risk situations, as opposed to the discernment of general, nonlethal suicide behavior as a standard of practice (whether a patient is having suicidal thoughts or exhibiting an ambivalent suicide attempt potential). In the current study, verbalized suicide ideation information was unhelpful in the assessment of lethal risk. The Lethal Suicide Risk Assessment, Acute Model, and other dynamic, near-term risk models (such as the Acute Suicide Affective Disorder Model and the Suicide Crisis Syndrome Model)—going beyond elicited suicide ideation—need to be incorporated into current clinical suicide assessment training and become the legal standard of care for expected clinical behavior. Without this expanded clinical assessment perspective, the standard of care for suicide assessment is out of sync with current knowledge—an emerging dilemma for the forensic evaluation of suicide wrongful death cases.

Keywords: Forensic evaluation, standard of care, suicide, suicide assessment, wrongful death.

References:

[1] Gold, L.H. & Joshi, K.G. (2018). Suicide risk assessment. In Gold, L.H. & Frierson, R.L. (Eds.) Textbook of forensic psychiatry, 3rd Edition. Arlington, VA.: American Psychiatric Association Publishing, pp. 403-420.
[2] Melton, G.B., Petrila, J., Poythress, N.G., Slobogin, C., Otto, R.K., Mossman, D. & Condie, L.O. (2018). Psychological evaluations for the courts. 4th Edition. New York: Guilford Press, pp. 395-397.
[3] State of Missouri Case Law (2020). Title XXXVI Statutory Actions and Torts. Chapter 538—538.210. Standard of Care.
[4] Obegi, J. (2017). Probable standards of care for suicide risk assessment. Journal of the American Academy of Psychiatry Law. Vol 45, 452-459.
[5] Berman, A. L., & Silverman, M. M. (2014). Suicide risk assessment and risk formulation part II: Suicide Risk formulation and the determination of levels of risk. Suicide and Life-Threatening Behavior, 44(4), 432-443. doi:10.1111/sltb.12067
[6] Berman, A. L. (2017). Risk factors proximate to suicide and suicide risk assessment in the context of denied suicide ideation. Suicide and Life-Threatening Behavior. Advance online publication. doi:10.1111/sltb.12351
[7] Obegi, J. (2021). How common is recent denial of suicidal ideation among ideators, attempters, and suicide descendants? A literature review. General Hospital Psychiatry. Vol. 72, 92-95.
[8] Geis, B.D., Newman, F.L., Marzelak, J.M., & Edlavitch, S. (2023a). Patients who have had a serious suicide attempt and their unwillingness to go for psychiatric help. (Manuscript in preparation, unpublished data).
[9] Geis, B.D., Newman, F.L., Marzelak, J.M., & Edlavitch, S. (2023b) Exploratory patterns of lifetime and acute suicide risk: Novel combinations of actionable lethal risk variables (Submitted, Current Psychiatry Research and Reviews).
[10] Shneidman, Edwin S. (1985). The definition of suicide. New York, NY: Wiley.
[11] Tucker, R. P., Michaels, M. S., Rogers, M. L., Wingate, L. R., & Joiner Jr., T. E. (2016). Construct validity of a proposed new diagnostic entity: Acute Suicidal Affective Disturbance (ASAD). Journal of Affective Disorders, 189, 365-378. doi:10.1016/j.jad.2015.07.049
[12] Joiner, T. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
[13] Brown, G.K. (2002). A review of suicide assessment measures for intervention research with adults and older adults. (Technical report submitted to the National Institutes of Mental Health under Contract No. 263-MH914950). Bethesda, MD: National Institute of Mental Health.
[14] Ellis, T.E. (Ed.) (2006). Cognition and suicide: Theory, research, and therapy. Washington, D.C.: American Psychological Association Press.
[15] Linehan, M. M. Heard, H., Brown, M., & Wagner, A. (2001). The Parasuicide History Interview. Unpublished manuscript. Retrieved from http://blogs.uw.edu/brtc/
[16] Arbuckle, J.I. (2013). Amos 22.0 User’s Guide. Crawfordville, FL: Amos Development Corporation.
[17] Kline, R.B. (2005). Principles and practice of structural equation modeling (2nd ed.). New York: Guildford Press.
[18] Yaseen, Z.S., Hawes, M., Barzilay, S. & Galynker, I. (2019). Predictive validity of proposed diagnostic criteria for the Suicide Crisis Syndrome: An acute presuicidal state. Suicide and Life-Threatening Behavior. Vol 49(4), 1124-1135.
[19] Geis, B.D. (2020). Brief dynamic suicide assessment and rapid suicide risk reduction. Manual for the Health Forward Foundation’s Enhanced Suicide Care Academy. December 2020, Kansas City, Missouri.