Risk Management and the Suicidal Patient

Abstract

In the management of the suicidal patient, fear of criticism or adverse findings by coroners’ courts can inappropriately influence a clinician's decision-making. The management particularly of the patient with borderline personality disorder, who deliberately self-harms or is suicidal, is made more challenging by the negative transference these patients may evoke.Adherence to evidence-based practice – excluding comorbid or differential diagnoses, crisis management, judicious hospital admissions, targeted medication and appropriate outpatient therapies – as well as detailed contemporaneous documentation of the decision-making are the mainstays of risk management of the patient with borderline personality disorder. The management plan should be informed by cross-sectional risk assessments and serial risk-benefit analyses. After providing illness education, the scenario planning and crisis intervention plan should be agreed with the patient and the patient's family and supports. Maintaining continuing professional development and peer review will also best approximate the “peer professional opinion” which is mandated by the various Civil Liability Act provisions in all Australian jurisdictions.