“No Suicidal Ideation”: An Inadequate Managed Care Response

Abstract

Back to table of contents Previous article Next article LettersFull Access“No Suicidal Ideation”: An Inadequate Managed Care ResponseKim J. Masters, M.D.Kim J. MastersSearch for more papers by this author, M.D.Published Online:13 Jan 2015https://doi.org/10.1176/ps.62.11.pss6211_1394aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: “Your patient is denying suicidal ideation, so he does not meet our criteria for continued acute hospital psychiatric care.” This is a refrain that I have frequently heard from managed care reviewers, particularly those authorizing only ultrashort hospital stays (1). However, individuals who are familiar with malpractice litigation of wrongful deaths know that asking only about suicidal ideation is considered prima facie evidence of an inadequate suicide risk assessment (2).A recent article in the journal Focus proposed instead the evaluation of static, dynamic, and risk reduction factors as a comprehensive method of understanding a patient's risk of suicide (3). Static risks are defined as factors that do not change, such as age, sex, personal losses, history of suicide attempts, previous relationship ruptures, and family history of mental illness. Dynamic factors are changeable factors, such as mood, goals, impulsivity, hopefulness, and access to firearms. Risk reduction factors include being pregnant, being a caregiver for children, being employed, and having positive therapeutic and social support (3).An inpatient's denial of suicidal thoughts to an interviewer provides no information about changes that may have occurred to modify the severity of static factors, alter dynamic ones, or promote risk reduction elements in a patient's intention to kill him- or herself. It is simply the answer to a question.If reviewers for managed care companies and their physician advisors are committed to helping our patients effectively use financial health care resources, then their reviews of the treatment of suicidal patients must obtain information about what has changed in a patient's life during hospitalization that reduces the wish to die or increases the will to live. “No suicidal ideation” leaves this to the imagination of the beholder and is unworthy of our uncritical acceptance.Dr. Masters is affiliated with Three Rivers Midlands Campus, a residential treatment facility in West Columbia, South Carolina.Acknowledgments and disclosuresThe author reports no competing interests.References1 Glick ID , Sharfstein SS , Schwartz HI : Inpatient care in the 21st century: the need for reform. Psychiatric Services 62:206–209, 2011 Link, Google Scholar2 Resnick PJ : Psychiatric malpractice. Audio Digest Psychiatry 39(13): July 7, 2010 Google Scholar3 Jabbarpour YM , Jayaram G : Suicide risk: navigating the failure modes. Focus 9:186–193, 2011 Crossref, Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 62Issue 11 November 2011Pages 1394-1395 Metrics Acknowledgments and disclosuresThe author reports no competing interests.PDF download History Published online 13 January 2015 Published in print 1 November 2011