Suicidal Clients: Law, Ethics, and Documentation
Pollack, Daniel, Policy & Practice
The "National Hospital Ambulatory Medical Care Survey: 2003 Emergency Department Summary" reports that in the United States there were 31,655 suicides in 2002; suicide is the 11th leading cause of death in the United States; every 18 minutes a life is taken due to suicide. Globally, the World Health Organization estimates that in the year 2000 approximately 1 million people died from suicide. This is a global mortality rate of 16 per 100,000, or one death every 40 seconds.
As a result of the suicide of their son Tom, his parents filed a wrongful death action against the Department of Human Services, the social worker and the supervisor. They assert claims for general and professional negligence and they allege that the defendants failed to meet the standard of care of the human service profession generally in its treatment of their son because the institution/agency did not (1) monitor him closely enough, (2) communicate properly with him and (3) properly treat him for his mental illness and drug abuse. They further allege that at the time of their son's discharge from care, there was evidence that Tom was at risk for committing suicide.
The setting: A public mental health hospital? A medical hospital? A foster home? A group home? A county jail, halfway house, prison? In truth, it could be any of these settings. The defendants, of course, contend that Tom did not pose an immediate threat to himself. In the end, each side submits evidence and affidavits supporting its view of the tragedy.
The fact patterns of suicide cases are limitless. In each one, many factors come into play. In some states, human service workers can be held liable for the acts of a client only if the institution had physical control over the client at the time of the incident. All states demand a showing that the person's death was proximately caused by a breach of duty by the workers. Some states insist that there be evidence that the suicide could have been avoided. California's law is typical. As a general rule, a human service or mental health practitioner has no duty to predict a patient's dangerous propensities. But this rule is subject to an important exception: when a patient has "communicated to the psychotherapist a serious threat of physical violence against a reasonably identifiable victim," the professional must take reasonable steps to warn the victim and a law-enforcement agency of the threat. (Civ. Code, [section] 43.92, subds. (a), (b) (section 43.92).)
With ongoing professional mandates of ethical practice standards, human service workers must keep current with issues affecting ethical decision-making and competent practice. …