Institutional Risk Management Education and Consultation (IRMEC): A Jurisprudent Science Perspective

By Gutheil, Thomas G.; Drogin, Eric Y. et al. | Journal of Psychiatry & Law, Fall 2007 | Go to article overview

Institutional Risk Management Education and Consultation (IRMEC): A Jurisprudent Science Perspective


Gutheil, Thomas G., Drogin, Eric Y., Friedman, Rohn S., Journal of Psychiatry & Law


Institutional Risk Management Education and Consultation (IRMEC) represents an application of the combined knowledge bases of occupational and organizational psychiatry, organizational psychology, and forensic psychiatry and psychology, to the specific context of risk management in hospitals and other healthcare organizations. The two primary dimensions of IRMEC are: (1) evaluation and education with respect to psychiatric risk management; and (2) consultation and education with respect to psychiatric aspects of general medical practice. From a "jurisprudent science" perspective, the "science" underlying IRMEC-based treatment interventions is well founded, its "practice" includes harmonizing institutional policy and clinical judgment, and its "roles" are grounded in traditional sources of ethical guidance for psychiatrists and psychologists.

The problem of individual and institutional liability for alleged mental health malpractice needs no emphasis in the present era, but the usual responses of fear, anger and resentment may be replaced usefully by proven and practical professional interventions. This article describes a psychiatrically informed approach to Institutional Risk Management Education and Consultation (IRMEC), analyzed from a Jurisprudent Science perspective that focuses upon the legal correlates of psychiatric science, psychiatric practice, and psychiatric roles (Drogin & Barrett, 2007).

Psychiatric science

Historians have identified instances of medical consultation dating back as far as the 13th century, and by the 19th century this mode of service delivery was widely available to individual practitioners (Brown, Pryzwansky & Schulte, 2006). As the practice of medicine became increasingly institutionalized in the 20th century, the newly established specialty of psychiatric consultation was duly integrated with general hospital and medical school settings (Friedman & Molay, 1994). More recently, the pervasive influence of psychiatric consultation has enabled the participation of allied mental health professions as well (Drogin & Barrett, 2007).

Consultation to an individual patient and clinician has been followed by institutional consultations. These consultations involve the use of psychiatric expertise to address institutional or systems issues. The current range of institutional psychiatric consultation is broad, including consultation for business purposes (addressing organizational behavior, issues in family-owned businesses, motivational issues, and personality assessment in hiring decisions); for governmental purposes (addressing criminal profiling, war game analysis, and interrogation techniques); and for educational purposes (addressing developing education plans for special needs, crisis plans, and development of school-based prevention and treatment plans) (Kahn, 2006). A professional organization, the Academy of Organizational and Occupational Psychiatry, was founded in 1990 to address corporate and workplace psychiatric consultation, and the November 2006 issue of Psychiatric Annals was devoted to "Occupational and Organizational Psychiatry" (Dhaliwal, 2006).

IRMEC represents the application of the knowledge base of occupational and organizational psychiatry, organizational psychology, and forensic psychiatry and psychology to the specific context of risk management in hospitals and other healthcare organizations. There are two primary dimensions of the application of these sciences in this context:

1. Evaluation and Education with Respect to Psychiatric Risk Management: This includes: (a) risk review of the existing systems in a psychiatric treatment context (psychiatric inpatient unit or ambulatory setting), to look for areas in which patient safety and litigation risks may be identified such as policies and procedures for documentation, seclusion and restraint, or risk assessment or architectural standards (Jayaram, 2006); and (b) education regarding psychiatric malpractice, psychiatric risk management, and liability prevention (Fenwick, Vassilas, Carter & Haque, 2004; Mossman & Kapp, 1997). …

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