Psychiatric Opinions Research Articles

Aide active à mourir et maladie mentale : le concept d’incurabilité est-il scientifiquement acceptable et éthiquement recevable ?

Laws granting the right to obtain active assistance in dying initially concern people suffering from incurable illnesses that cause unbearable suffering and are life-threatening in the short to medium term. But these laws are always followed by proposals and debates aimed at extending the indications for euthanasia or assisted suicide to incurable conditions, even if they are not life-threatening, as soon as they cause unbearable suffering. And so it is that some countries accept psychiatric illnesses that are declared incurable as indications for access to active assistance in dying. In Belgium and the Netherlands, for example, the press has reported on cases of people suffering from depression or post-traumatic stress disorder who have been euthanized at the end of an authorization process that involves two psychiatric opinions declaring their condition incurable, without any collegial reflection on the diagnosis or the therapeutic programs implemented. Depression and post-traumatic stress disorder, however, account for less than half of all indications for euthanasia for psychiatric illness in Belgium. That leaves us with patients labelled psychotic and with ill-defined personality and behaviour disorders. Psychiatric indications for euthanasia raise their own specific ethical issues. How can we fail to underline the uncertainty and complexity of the diagnosis, which cannot, as a rule, be supported by imaging or biology? How can we understand that indications for euthanasia are accepted for patients with several psychiatric diagnoses? From one end of the procedure to the other, the problem is to obtain the opinions of two psychiatrists declaring that the disorders are incurable, that the suffering is intolerable and that the patient's capacity for discernment is intact. The decision thus stems from a libertarian paternalism convinced of the humanist dimension of active aid in dying, and which results in an incentive (nudge) whose aim, set by the law, is only to know whether the suffering is incurable, without calling into question the diagnosis and therapeutic programs. How can we say that a mental illness is incurable? How can we distinguish between a depressed person's disgust with life and so-called existential suffering? How can we reconcile preventing suicide in cases of depression and social isolation, while at the same time encouraging assisted suicide or euthanasia for the same people? What are the criteria for verifying that the capacity for discernment has been preserved? Is there not a danger, in the name of autonomic relentlessness, of declaring that a person is autonomous when in fact he or she is subject to the heteronomy of depression, delirium or obsessive disorders? The world of psychiatry cannot avoid such questions. The American Psychiatric Association, for example, has adopted the position on medical euthanasia holding that “a psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death”. Other psychiatric associations have hesitant positions. The debate must be opened. It must involve all those who treat, care for and support people of all ages whose mental health is suffering. It must also concern every citizen.

Guilty or not guilty by reason of insanity? a comparative study of murderers referred for psychiatric examination by court order

BackgroundSome murders are committed under the influence of a psychotic state resulting from a mental disorder, mainly schizophrenia. According to the law in many countries, people with mental disorders do not have criminal responsibility. They are defined as not guilty due to insanity (insanity defense) and therefore cannot be punished. In Israel, in recent years, more lawyers are requesting psychiatric opinions for the murder defendants they represent. This study aims to explore the differences between two groups of murderers: individuals who committed murder and were found not guilty by reason of insanity (NGRI) and individuals who committed murder and were found responsible and guilty. The comparison is made from a broad perspective by examining sociodemographic factors and psychiatric factors as well as criminological and forensic factors.MethodsThis study, conducted in Israel, analyzes the sociodemographic and forensic differences between 72 individuals who committed murder and were found not guilty by reason of insanity (NGRI) and 56 individuals who committed murder and were found responsible for their actions and fit to stand trial (guilty).ResultsThe findings show that NGRI participants were more likely to be from central areas, to be Jewish (rather than Arab), to be diagnosed with schizophrenia and have a background of hospitalizations before committing the murder, to have remained at the murder scene and/or called for help, and to be less likely to have committed the murder with a partner.ConclusionsThe study’s findings are explained and the limitations discussed. The findings add to the existing knowledge base about murder by reason of insanity and the differences between NGRI and criminal murderers. The characteristics of the NGRI group found here can help to identify risk groups and to develop and implement prevention programs for people with mental disorders who are at risk of violent behavior.

Risiko for bias i retspsykiatriske vurderinger

AbstractTo reach better-informed decisions about psycho-legal issues, courts in Denmark and other countries request psychiatric and psychological expertise opinions on emotional, behavioral, and/or cognitive functioning of charged individuals and on court sentencing for convicts. The process of professional decision-making has, however, for decades been recognized as vulnerable to becoming biased. Biases are a potential result of humans’ applying cognitive short-cuts ( heuristics) to ensure fast and effective decision-making. While bias in forensic psychiatry has been examined internationally, this subject has been issued only scarcely in Denmark. This paper aims to introduce to theoretical basics and empirical findings on bias, cognitive heuristics, and debiasing strategies broadly and specifically to forensic psychiatry. The objective is to inform and improve professional practice within forensic psychiatry.

Criminal liability and epilepsy: a case report of a postictal attempted homicide from Tunisia.

Patients with epilepsy who have been charged with a serious offense may be referred by the courts for forensic psychiatric examination. A detailed psychiatric and neurological examination is often necessary to assist the courts in making the right decision, as exemplified in the current case presentation. The forensic case of a 30-year-old Tunisian male with temporal epilepsy who exhibited an inadequate response to the treatment is presented here. The patient attempted to kill his neighbor after a cluster of seizures, showing apparent postictal aggression. An antiepileptic treatment was introduced a few days after the person's detention and was followed by forensic psychiatric examination, but the latter was not done until three months afterwards. On forensic examination, the patient's thought processes were clear with no evidence of a thought disorder or psychosis. Both medical and psychiatric opinions stated that the attempted homicide was due to a postictal psychosis. The patient was transferred to a psychiatric facility for further management and was found not guilty by reason of insanity. This case illustrates the difficulties that experts may encounter in establishing criminal liability after aggressive behavior associated with epilepsy. It highlights shortcomings in Tunisian law (and promptness of forensic psychiatric examination) that should be addressed to ensure fairness of the legal process.

Psychological and sexological characteristics of rape perpetrators - first report

IntroductionFor many years, the crime of rape has been the focus of attention of numerous representatives of criminal law doctrines, psychologists and sexologists, and is also part of the considerations of courts and penitentiary centers.Statistical reports made available by the police clearly indicate that in recent years the problem of sexual crime has been growing, especially crimes consisting in committing a forbidden act such as rape or sexual murder.However, complete and objective data on the prevalence of sexual offenses are very difficult to obtain. Data from the judiciary statistics reveal only a narrow part of the problem of rape.ObjectivesThe project involves the analysis of the collected research results, the result of which will be the preparation of a report - a psychological and sexological profile - the characteristics of the convicts. The indicated analysis will be the result of research conducted in several penal facilities in the territory of Poland, including: Kraków, Warsaw, Poznań and others. on a research group comprising about 15% of the total number of prisoners for this crime.MethodsThe source of data on sexual offenders will be data obtained as a result of direct examinations of persons charged with rape, forensic psychiatric opinions, forensic psychological opinions and sexological opinions issued in their cases based on psychiatric and sexological tests commissioned by the court. The research material comes from the files of the perpetrators made available for the purposes of the study by the Central Board of the Prison Service. The authors of the project created a comprehensive perpetrator questionnaire containing a range of data including items on life line, origin, education, work, sexual preferences, sexual life, sexual initiation, psychiatric diagnoses and disorders of sexual preferences and personality.ResultsA preliminary review of the available material gives grounds to conclude that the data it contains is comprehensive and has enormous scientific value. The created tool (based on a comprehensive analysis of the material) by the research team also includes items on the course of the act itself, the method of searching for victims, the method of persuading or forcing victims to submit to sexual activities, the repetition of the act and, finally, the perpetrator’s relationship to the criminal act committed by him.The final report will be presented at the EPA conference.ConclusionsThe presented report will allow to get to know the characteristic elements of the psychological and sexological profile is a necessary condition for developing an effective strategy of social rehabilitation interactions.Disclosure of InterestNone Declared

Court-Ordered forensic psychiatric evaluations for offenders with schizophrenia with homicide charges in Taiwan

Background: Homicidal offenders with schizophrenia who went through psychiatric evaluations are a small but significant group during a criminal appeal. Aim: Our aims are to explore whether the types of crime, such as homicide or not, would be related to the verdicts for the alleged offenders with schizophrenia in Taiwan. Our hypothesis was that homicide cases, rather than other alleged offenses, would be more likely to be regarded as no responsibility (legal insanity) or diminished responsibility for those defendants in the forensic psychiatric evaluation opinions or the court verdicts. Methods: A retrospective comparison of the homicide offenders with the nonhomicide offenders with schizophrenia, registered between December 2000 and November 2009, was conducted in the web-based, national, open-access court verdict databank. Results: There were 33 (3.4%) in 9691 criminal homicide offenders that had a diagnosis of schizophrenia. There were 33 in the homicide group and 22 in the nonhomicide group. Among these defendants in the homicide group, 3 (9.1%) were regarded as legal insanity, and 21 (63.6%) were regarded as diminished responsibility in comparison to the zero (0%) as legal insanity and nine (40.9%) as diminished responsibility in the nonhomicide group (P = 0.029). In addition, the group with multiple evaluations tended to receive forensic psychiatric opinions as legal insanity (N = 3; 33.3%), and the group with single evaluation tended to receive forensic psychiatric opinions as diminished responsibility (N = 16; 66.67%) (P = 0.017). The group with multiple evaluations tended to be ruled as legal insanity in the court (P = 0.001). Conclusion: Homicide cases would be more likely to be regarded as legal insanity or diminished responsibility for the defendants with schizophrenia in the forensic psychiatric evaluation opinions or the court verdicts.

Long-term forensic psychiatric inpatient treatment - review of the selected literature and the analysis of data from the medium secured forensic psychiatry unit.

The aim of this study was to perform an analysis of the risk factors of long-term psychiatric detention, defined as a stay in forensic institution exceeding respectively 60 and 84 months, based on data obtained from 150 patients from medium secure forensic psychiatry unit. The discussion was preceded by an analysis of the available literature in this field. The sociodemographic factors, the course of the mental disorder, the characteristic of committed criminal acts, aggressive or self-destructive behavior and the clinical characteristic of the illness in the last 6 months of psychiatric detention were analyzed. A pilot study was based on a retrospective analysis of data from medical records and psychiatric experts' opinions of a cross-sectional nature. Due to the variables' characteristic, the Student's t-tests, Spearman's correlation and the Kruskal-Wallis rank ANOVA were used. Risk of long-term hospitalization significantly correlated with factors related to the course of the last 6 months of inpatient treatment, including the mental state of patients, the occurrence of aggressive behaviors and the response to pharmacological treatment. There was no significant effect of demographic factors or coexisting addiction to alcohol and psychoactive substances. The risk of long-term psychiatric detention increased with the duration of the illness. There were no correlations with the age of the patients at the time of admission nor number of detentions. The nature of the diagnosis was also not found to be a risk factor. Our study is the first systematic attempt to assess the risk factors of long-term psychiatric detention in a group of patients of forensic psychiatry centers in Poland. We hope that the presented results will rise a discussion on the shape of psychiatric care in Poland and encourage further research in this area, as well as they will contribute to the optimization of the treatment process.

Improving the Referral Process Between Acute Wards and the Psychiatry Department at Tameside General Hospital

AimsThe project aims to address the barriers faced by the acute hospital and the psychiatry department in the referral process for a psychiatric opinion, at Tameside General Hospital (TGH). The Care Quality Commission (CQC) undertook a review of how people's mental health needs were met in acute hospitals in 2017 and concluded that there were barriers to this, for multifactorial reasons. Examples included: acute hospital staff not feeling adequately prepared to treat mental health conditions and lack of mental health care services 24/7. The current referral process at TGH for the acute hospital doctors requesting a psychiatric opinion presents a challenge for the referring doctor and psychiatry doctor in receipt of the referral. Many at the acute hospital have found the process of referral unclear, and many in the psychiatric department have found that referrals seldom contain sufficient information to determine whether a psychiatric review is required and whether it needs to be prioritised.MethodsTo understand the specific difficulties encountered during the referral process, two questionnaires were created. One for TGH acute trust doctors and one for the psychiatry doctors, asking what the perceived barriers were and how these could be overcome. Data were collected between September and October 2021.ResultsWe obtained results from 17 acute trust doctors. The results revealed that most referring doctors found the referral process unclear. 100% agreed that they would benefit from guidance with the referral process e.g., a psychiatry specific referral form and/or a flow chart outlining the referral process. All responders wanted guidance around the roles and responsibilities of the psychiatric team in relation to the hospital setting.We obtained results from 7 psychiatry doctors. Most were not satisfied with the referrals received. 100% would like to see a specific psychiatry referral form implemented in the acute hospital.ConclusionKey findings were: the referral process is unclear, acute trust doctors don't feel well enough equipped to manage mental health concerns, referrals don't contain sufficient patient information, and that the acute trust doctors don't know where to ask for help. The project reflected earlier CQC findings.After discussion with the acute trust, our action plan includes creating a psychiatry-specific referral form, to be distributed together with a flow chart which directs acute trust doctors to the appropriate source for psychiatric opinions. We also aim to join departmental and junior doctor teachings regularly to distribute and educate on the process.

Romanian psychiatric residents' opinions on factors that influence their decision to emigrate: A 5-year follow-up study.

To evaluate the situation of migration of psychiatrists from Romania and a prioritization exercise of main factors related with psychiatric residents' decision to emigrate could be a starting point of elaboration of a strategy of reforms. Important changes have been done in economic status of residents in 2018. The impact of these measures in changing opinions was checked. This is a cross sectional evaluation study on a randomized selected sample of Romanian psychiatric residents' opinions on factors that influence decision of migration in EU countries in two time points, 2015 and 2020. Thirty-eight percent of residents intend to work abroad comparing with 78% before the economic changes (25.8% vs. 71.7% for a limited period of time and 15.7% vs. 28.3% intend to emigrate) and 2% vs. 5% intend to leave the specialty. The important factors for decision to emigrate changed from "Better working conditions" (15.7% vs. 37.3% residents) to "Better training"; the factor "respect and appreciation by colleagues" remained important for 19.1% versus 17.9%. "Lack of working place for partner" was considered by 26.7% of responders as an important disadvantage of working abroad. "Being far from family members", which was considered 5 years ago by 64.2% of responders as an important disadvantage of working abroad, nowadays concerns only 6.7%, probably because it seems easier to go abroad together with the family members. The factors (better training in psychiatry and psychotherapy, better supervision, more involvement in research) that influence the residents' decision to emigrate represent the starting points for future reforms in educational and medical system in psychiatry.

Clinical Reasoning in Forensic Psychiatry: Concepts, Processes, and Pitfalls.

Forensic psychiatrists are often sought by the court of law to provide professional opinion on specific legal matters that have a major impact on the evaluee and possibly society at large. The quality of that opinion and recommendations rely on the quality of the analysis from the assessment results conducted by the psychiatrist. However, the definition and scope of a forensic psychiatric analysis is not clear. While existing literature on forensic psychiatric analysis generally includes organizing information, identifying relevant details, and formulating a set of forensic psychiatric opinions as components, there is no explicit and unified definition of these terms and process. This lack of clarity and guidelines may hinder forensic psychiatry from achieving its goal of providing objective information to the court or other relevant parties. Forensic psychiatric analysis exhibits numerous parallels to clinical reasoning in other fields of medicine. Therefore, this review aims to elaborate forensic psychiatric analysis through the lens of clinical reasoning, which has been developed by incorporating advances in cognitive sciences. We describe forensic psychiatric analysis through three prominent clinical reasoning theories: hypothetico-deductive model, illness script theory, and dual process theory. We expand those theories to elucidate how forensic psychiatrists use clinical reasoning not only to diagnose mental disorders, but also to determine mental capacities as requested by law. Cognitive biases are also described as potential threat to the accuracy of the assessment and analysis. Additionally, situated cognition theory helps elucidate how contextual factors influence risk of errors. Understanding the processes involved in forensic psychiatric analysis and their pitfalls can assist forensic psychiatrists to be aware of and try to mitigate their bias. Debiasing strategies that have been implemented in other fields of medicine to mitigate errors in clinical reasoning can be adapted for forensic psychiatry. This may also shape the training program of general psychiatrists and forensic psychiatrists alike.

A Study of Criminal Manifestation and Characteristics of Elderly Mental Illness

Objective: As the population of the elderly increases, the prevalence of dementia and other mental diseases of the elderly is also increasing. Dementia is a typical elderly mental illness. Some people with dementia may cause a crime due to symptoms of mental behavior. The purpose of this study is to examine the characteristics of criminal behavior of various elderly mental patients. Methods: From January 1, 2010 to December 31, 2019, the court selected 65 years of age or older from among the criminal psychiatric appraisal cases commissioned by the court. A total of 205 medical records and mental assessments were reviewed retrospectively. All records were prepared through psychiatric interviews, clinical psychological examinations, and other examinations, and the information compiled was viewed in several aspects, including demographic factors, crime characteristics, and psychiatric opinions, at the level of technical analysis. Results: There was a statistically significant difference in the judgment of criminal liability according to the degree of cognitive impairment (p<0.001) in the elderly mentally ill, and a significant difference in criminal behavior depending on the type of mental illness (p<0.001). Conclusion: Not only dementia but also other elderly mental illnesses are related to violent crime. In particular, paranoid symptoms and alcohol abuse in older adults’ mental illness are related to the type of criminal behavior. In an aging society, appropriate therapeutic intervention is needed to prevent criminal behavior of the elderly mentally ill.

Textual strategies of forensic psychiatrists. A corpus-based analysis of how the language of psychiatry is reconciled with the language of law in polish forensic psychiatric opinions

The role of an expert forensic psychiatrist is likened with that of a translator: their task is to translate the language of medicine into the language of law. The aim of the article was to reconstruct the textual strategies adopted by forensic psychiatrists in terms of reconciling the discourses of law and medicine. The analysis covered 65 opinions/reports issued at a psychiatric reference centre in Poland. Thanks to the application of the innovative corpus linguistics methodology, the singularities of forensic psychiatric opinions as a genre have been captured and the degree of its conventionalisation has been assessed. The findings indicate that psychiatric opinions have not yet achieved the status of a homogenous genre, and the standardisation and formalisation processes have only reached the structural level. The expert psychiatrists constrained the presence of the author's voice and did not use the narrative form in their opinions. The analysis also captured the ethical challenges related to the dual role of forensic psychiatrists as medical doctors and representatives of the judicial system.

Du parricide rêvé à l’infanticide réel, ou l’expertise mentale dans tous ses états

The authors describe at length the case of a 33-year-old woman who shot and killed her 9-year-old daughter and attempted suicide immediately afterwards. The judicial inquiry revealed that this infanticidal mother originally intended to kill her own father, who she accused of having sexually abused her in her own childhood and now her daughter, but that unforeseen circumstances changed the mode of operation. She was the subject of seven more or less contradictory psychiatric experts opinions over a period of more than three years before finally being found criminally irresponsible by the court of assizes. She was suffering from delusional psychotic mental disorders at the time of the homicide-suicide. The authors discuss and criticize the conclusions of the experts opinions and instead recommend a multidisciplinary criminological analysis that takes all the objective ans subjective aspects on the case into account.

Psiquiatria e naturalização do crime passional no Rio de Janeiro da década de 1930

Resumo Este artigo visou contribuir para a historicização da violência de gênero no Brasil por meio da análise de casos de crimes passionais presentes nas páginas do periódico Arquivos do Manicômio Judiciário do Rio de Janeiro na década de 1930, momento em que tais crimes ganharam contornos de problema social com a efervescência do debate público a seu respeito. Assim, por meio de laudos psiquiátricos, jurisprudência e pareceres do Conselho Penitenciário do Distrito Federal publicados no periódico, o texto analisa a reificação e a naturalização da violência contra as mulheres no âmbito da psiquiatria forense do Rio de Janeiro (RJ) e o embate desta com outros posicionamentos.

Transition as a topic in psychiatry training throughout Europe: trainees' perspectives.

The majority of adolescents with mental health problems do not experience continuity of care when they reach the transition boundary of their child and adolescent mental health service. One of the obstacles for a smooth transition to adult mental health services concerns the lack of training for health-care professionals involved in the transition process. This study aims to seek psychiatric trainees' opinions regarding training on transition and the knowledge and skills required for managing transition. A survey was distributed to trainees residing in European countries. Trainees from 36 countries completed the questionnaire, of which 63% reported that they came into contact with youth and young adults (16-26years) during their clinical practice. Twenty-seven percent of trainees stated they have good to very good knowledge about the transition process. Theoretical training about transition was reported in only 17% of the countries, and practical training in 28% of the countries. Ninety-four percent of trainees indicated that further training about transition is necessary. The content of subsequent transition-related training can be guided by the findings of the MILESTONE project.

Crime et châtiment de Dostoïevski : une lecture comportementale du double homicide de Raskolnikov

This medico-literary study analyzes the behavior of the modus operandi of Raskolnikov's double homicide based solely on Fyodor Dostoevsky's novel Crime and Punishment. The following themes are discussed: the selection of the chapters of the novel that provide useful information; Raskolnikov's mental state according to the modern American diagnostic classification; the motives for his criminal action; how he organized the double homicide, from its psychological and material preparation to its perpetration; crime as a means of confessing guilt (crime by self-punishment); various literary and psychiatric opinions on Raskolnikov and his crime. The analysis of all this information shows this double homicide to have been clearly prepared, planned and executed (high operational component). Despite the mental disorders he suffered from, Raskolnikov technically succeeded, although he did not derive any material or psychological benefit from his crime. He turned out to be a good assassin but an inept thief, his strong sense of guilt leading him to make mistake after mistake until his arrest.

Psychiatric Patients’ and Nurses' Opinions About Limit Setting Technique in Port-said City

BackgroundLimit setting facilitates the development of a therapeutic, caring and supportive relationships, it can also decrease patients' feelings of anxiety and uncertainty. It is a two-way process that should be delivered professionally by the nurse and perceived therapeutically by the patient, so patient considered a vital participant of the technique. AimThe present study aimed at exploring psychiatric patients' and nurses' opinions as well as their information about limit setting. MethodAll nurses working at the hospital and working along the day (the three day shifts) were included in the study (N=88), as well as all convenient patients that were willing to participate in the study (N=104).In order to collect data for the present study, three open-ended structured questionnaires were developed by the researcher. ResultsPsychiatric nurses working at Port-Said psychiatric hospital have insufficient information concerning limit setting in which use of threats and authoritarian communication is nurses' style of application. Regrettably, nurses of the present study disagreed with essential and indispensible principles that should be followed when setting limits. Concerning psychiatric patients, the study revealed that patients had negative experiences with limit settings that contributed to enforcement of misconceptions and negative opinions about limit setting. Also, psychiatric patients viewed limit setting technique as nurses' way of punishment as well as humiliation. RecommendationsProviding nurses with sufficient information about different psychiatric nursing skills such as communication skills and use of restraint; through holding educational workshops and seminars. Secondly, nurses need specific and professional training course accompanied with clinical application or simulation. As regard psychiatric patients, providing courses by professional and competent nursing staff regarding limit setting emphasizing its therapeutic uses and outcomes is a must; in order to correct misconceptions they acquired.

Attitudes of Chinese community members and psychiatrists towards forensic psychiatric assessments

The aim of this study was to investigate the attitudes of Chinese community members and psychiatrists towards forensic psychiatric assessments. A questionnaire designed to record attitudes toward the current forensic psychiatric assessment procedures and the disposal of mentally ill offenders was developed and distributed via a mobile App. A total of 134 community members and 132 psychiatrists voluntarily completed the questionnaire. Most of responders agreed that the department of public-security has the right to apply for a forensic psychiatric assessment but should not be held solely by that department. Community members were less significantly confident in the validation of forensic psychiatric opinions than were the psychiatrists. A significantly higher proportion of community members than psychiatrists considered that offenders judged Not Criminally Responsible on Account of Mental Disorder (NCRMD) should be punished as would be sane people. In addition, only a minority of responders supported that NCRMD should not be held criminally responsible. Our results indicate that both groups have comments on the current distribution of right of startup of forensic psychiatric assessments. Compared to psychiatrists, community members have lower confidence in the validation of forensic psychiatric assessment and have stricter attitudes toward the disposal of offenders with psychiatric disorders.

Goldwater Rule Still Stands Firm As Ethics Guideline for Psychiatrists

Goldwater Rule Still Stands Firm As Ethics Guideline for Psychiatrists

Assessing Suicide Risk: What is Commonly Missed in the Emergency Room?

Although risk assessment for suicide has been extensively studied, it is still an inexact process. The current study determined how busy emergency clinicians actually assessed and documented suicide risk, while also examining the differences between psychiatric and emergency medicine opinions on the importance of various suicide predictors. Phase 1 of the study involved the administration of a survey on the relative importance of various suicide predictors for the specialties of psychiatry and emergency medicine. In phase 2 of the study, a chart review of psychiatric emergency room patients was conducted to determine the actual documentation rates of the suicide predictors. Several predictors that were deemed to be important, including suicidal plan, intent for suicide, having means available for suicide, and practicing suicide (taking different steps leading up to suicide but not actually attempting suicide), had low documentation rates. Medical specialties have different opinions on the importance of various suicide predictors. Also, some predictors deemed important had low documentation rates. Educational interventions and simple assessment tools may help to increase documentation rates of several suicide predictors in busy clinical settings.