Facilities that provide inpatient care to patients experiencing mental health issues have a strong obligation to make sure patients are carefully monitored and appropriately treated to prevent an attempted suicide. When patients are depressed and experiencing suicidal ideation, it is especially imperative the institutions in charge of them take active steps to protect them.

Sometimes, however, institutions fall short. One such institution, which tells patients to “expect a miracle” is considered one of the foremost rehabilitation centers in the country. The strong reputation and appealing promises made by the institution led one family to pay $64,800 to get care for a 55-year-old man who had been struggling with chronic depression. The man’s admission to the rehabilitation facility was his first time in a residential treatment center, although he had previously been hospitalized for mental health issues. Unfortunately, Tucson.com reports the man died by suicide while under the care of the rehabilitation center.

In cases like this one, serious questions arise regarding whether the inpatient treatment center did enough to protect the residential patient or whether the center fell short. In this case, a lawsuit has been filed in response to the inpatient suicide, with family members claiming they were misled into thinking the patient would be safe and arguing the facility was negligent because staff members failed to notice the patient had not shown up for scheduled activities.

Responsibility for Inpatient Suicides

Despite its promises of miracle cures, the facility has faced trouble in the past with actually living up to its promises.  Five patients have died in the care of the facility since 2011, all of whom were men between the ages of 20 and 71. Three of the patients died of suicide, two hanging themselves with a shoelace and one hanging himself with a belt.

Because of problems with the provision of patient care, the state Department of Health Services has been heavily monitoring its operations. The monitoring requirement was imposed because the rehab center was not following its own policies on keeping track of where its patients were. In the case of the 55-year-old suicide victim, for example, the man did not show up for any of the five activities he was scheduled to attend. He also missed appointments.

When patients are 15 minutes late for an activity, staff members are supposed to look for them.  Interviews with staff members, however, revealed no one looked for this man for hours, until it was too late. Staff members also confirmed they did not know who was responsible for taking attendance of patients, reporting when a patient was absent, and calling for the initiation of a search to locate the patient.

It was especially important for the facility to take action here, as records show the suicide victim had described feelings of total helplessness and thoughts of suicide.  Inpatient facilities are supposed to be operated specifically to protect patients like this when they offer care to those experiencing thoughts of suicide and they need to be held accountable when they fail in fulfilling obligations.

Approximately six percent of deaths by suicide in the United States occur when patients are under care in a psychiatric hospital, a mental health facility, or a mental health unit of a hospital.  According to Psychiatric Times: “Inpatient suicides are viewed as the most avoidable and preventable because they occur in close proximity to staff.”

Understanding when and how these suicides occur is key to successful prevention of death by suicide. When psychiatric health professionals fail in effective monitoring and prevention, the facility where the patient was receiving treatment may be held accountable.

Understanding Death by Suicide in an Inpatient Setting

Psychiatric nurses in an inpatient facility generally experience a completed suicide every 2.5 years on average, although these suicides are widely considered the most preventable due to staff-member control of the environment and due to the greater control exercised over inpatients versus outpatients.  Why? See the end of this blog.

The greatest danger to patients of death by suicide occurs in unsupervised areas, and patients are most at risk at night or during hand-offs when one staff member leaves a shift and care transfers to another healthcare worker.  However, patients may die by suicide at any time when staff members fail to fulfill obligations to keep them safe.

The majority of deaths by suicide in psychiatric hospitals occur because of hanging, and 75 percent of the deaths occur in closets, bedrooms, or bathrooms of patient rooms—those hidden areas all nurses and hospital techs know about.  While suicide watch protocols are aimed at preventing these fatalities, they are failing. Why? The observation period is too long.  It takes approximately two minutes of hanging to have irreversible brain damage and five to six more minutes to die—either on the unit or on a respirator a few days later in another hospital where the patient has been transferred due to the emergency.   When the suicide watch protocol involves checking on the patient every 15 minutes (the time interval often selected), this allows sufficient time for the patient to successfully complete a suicide. More frequent monitoring of patients at risk for suicide is called for-usually one to one (where a staff member is within arm’s length) or line of sight monitoring.   In one study of patients who died by suicide in an inpatient facility, 51 percent of patients were being monitored on a 15-minute suicide observation protocol.

Inpatient facilities can also eliminate threats to patients by reducing patient access to tools and conditions which could facilitate death by suicide. For example, grab bars in showers and plumbing fixtures can be used by patients in an attempt to die by suicide.  Adding plates to grab bars and putting safeguards around plumbing fixtures, like stainless steel boxes, can help to eliminate environmental risks.

Staff members must also be able to recognize when patients are at the greatest danger of death by suicide.  Studies suggest in 60 percent of suicides among inpatients, the patient’s level of risk was not adequately determined by psychiatric professionals or the appropriate precautions were not taken based on the risk level identified.  Professional psychiatric staff must be accurate in diagnosing the level of suicide risk posed by each patient in an inpatient facility, and appropriate protocols must be followed to protect patients from harm based on their specific risk levels.

Skip Simpson says: “In a nut shell hospitals must stop providing suicidal patients with the means, time and opportunity to kill themselves. Patient safety is not the goal for these hospitals; it is profits. Simple patient safety rules will stop the suicides if greed is put to the side.”

In 2012, the National Action Alliance for Suicide Prevention and the Suicide Prevention Resource Center (SPRC) came together to develop a plan called “Zero Suicide.”

Zero Suicide was outlined in the 2012 National Strategy for Suicide Prevention, and the website for Zero Suicide indicates the “foundational belief” of the project is: “that suicide deaths for individuals under care within health and behavioral health systems are preventable.” Essentially, this means individuals should not be falling through the cracks and the healthcare system should take a systematic approach to patient care to prevent death by suicide – all of them.

Mental health care providers play a key role in Zero Suicide, because as National Council magazine indicates: “serious mental illnesses and addictions elevate suicide risk by 6-12 times over the general population’s.”

When people with mental health issues seek treatment, care providers must recognize the dangers, be alert to signs of suicidal ideation, and take necessary steps to offer services designed to eliminate risk. If a mental health care provider fails in obligations and a patient dies by suicide, the care provider may be held legally liable for mental health malpractice for deciding not to follow the standard of care which contributed directly to the patient’s attempted suicide and/or death.

Zero Suicide Can Be Effective at Reducing Suicide Risks

States throughout the country are embracing the systematic approach of Zero Suicide, including New York. New York’s view is when suicide deaths occur, the fatalities are because of systemic failures- which are precisely the type of failures Zero Suicide is intended to stop from occurring. As part of a Suicide Prevention Initiative in NY, a plan has been put in place to improve the quality of behavioral healthcare and put an end to these systemic failures.

New York is putting a systems approach into place in higher risk communities and among higher risk demographic groups. Steps being taken include:

• Improving inpatient and outpatient care to reduce or eliminate suicide deaths in state-operated psychiatric service systems.
• Involving multiple parties and institutions, including local county leadership, residential care providers, inpatient and outpatient care providers, mental health professionals, and substance use care providers, in developing a comprehensive care and support network.
• Embedding suicide care in the major organizations serving youth across the state.
• Raising levels of staff support and surveying staff members in mental health facilities on their readiness to provide effective suicide prevention care.
• Assisting organizations in creating effective management practices aimed at achieving Zero Suicides through team-based care.

In Zero Suicide approaches, suicide protocols should be incorporated within policies and procedures of healthcare facilities, and the suicide risk of all patients should be assessed. Suicide should be treated not as a symptom of a mental health disorder or substance abuse disorder but instead as a condition for which a patient receives direct treatment.

When a suicide risk is identified in patients, a safety plan should be developed and regularly reviewed to reduce the risk of death by suicide and to ensure patients are provided with necessary support.

Above all, clinical staff must be appropriately trained, must follow up with patients, and must ensure they are providing the level of care patients need to reduce risks.

Nationally-recognized suicide attorney Skip Simpson of the Law Offices of Skip Simpson has been appointed to the Board of Directors for the American Association of Suicidology, a non-profit organization devoted to educating the public about suicide and working to prevent future suicides.

“I am honored to be chosen to serve on the board for this important organization,” Simpson said. “I believe I can bring a wealth of knowledge to this charitable group about the legal implications of suicide, particularly for cases involving the wrongful death of someone by suicide. I also hope I can do my part for the American Association of Suicidology to bring more awareness to this extremely important issue.”

According to the American Association of Suicidology’s website, the “AAS is a charitable non-profit membership organization for all those involved in suicide prevention and intervention, or touched by suicide.  AAS is a leader in the advancement of scientific and programmatic efforts in suicide prevention through research, education and training, the development of standards and resources, and survivor support services.”

The AAS’s goals match attorney Simpson’s focus at the Law Offices of Skip Simpson. As an attorney, Simpson focuses on teaching suicide prevention and prosecuting suicide malpractice cases throughout the country.

Death by suicide remains one of the leading causes of death for certain age groups in the United States. Among young people 15 to 24 years old, suicide is the second leading cause of death, according to the AAS. Overall, an estimated 41,100 people of all ages die each year due to suicide, according to the AAS.

In most cases, more can be done to prevent suicides, according to Simpson. “Most people considering suicide give clear warning signs before they act on such thoughts,” Simpson said. “That’s why it’s critical that doctors properly diagnose someone seriously considering suicide. There’s no room error when it comes to such cases. That’s why I’m honored to work with families dealing with the loss of a loved one and proud to serve on the board of at the American Association of Suicidology.”

In 2014, a college student died by suicide following his first year at the University of Texas at Austin. Following his death, his parents began to advocate for legislation that would increase awareness of mental health resources on college campuses. College students are particularly vulnerable to the risk of suicidal ideation because they are often facing tremendous academic pressure and are away from family and support systems for the first time.

While colleges have counselors available, students may be unaware of the mental health services that can be provided to them. Counselors may also fail to notice signs of suicidal ideation among their patients, which can result in accusations of clinician malpractice. Protecting young people during a vulnerable time in their life is of the utmost importance and two new laws have passed that could make a substantial difference in saving lives.

A closer look at Texas college suicide rates

In Texas, suicide is the second leading cause of death for college-aged kids. Around a third of all college students in Texas are reportedly dealing with depression.

Senate Bill 1624 was championed by the parents of the University of Texas at Austin student who died by suicide. The Bill was signed into law and took effect recently. The law requires universities to provide students with information on suicide prevention services and mental health services during their orientation period.

The bill mandates the information be provided to students during either a live presentation or a video. The information may not be provided in paper form. The purpose of requiring a video is to ensure students actually receive the information. Dallas News reports the director of the Counseling and Mental Health Center at UT-Austin is making a video that schools statewide can use in order to fulfill the new legal requirement.

Senate Bill 1624 was one of two laws that recently took effect to try to reduce the risk of death by suicide among college students. The other law requires local universities create a web page providing information to students about how to contact the local health authority in the university community.

The purpose of the new laws is to make it easier for students to access information they need and to reach out for help.  The lawmaker who authored the legislation stated: “College students in particular are at an age or an environment [where it’s] even more difficult for them, to seek out help.”  Now, by providing the information at orientation and on an easy-to-access website, hopefully more students will reach out.

The strong push should be “zero suicide.” This concept is realistic—several organizations have drastically reduced suicides and others have reached the goal of zero.  If zero is not the right number, what is?

Once students do seek mental health services, it is up to counselors to recognize signs of suicidal ideation and to take action to help vulnerable students. The counselor may be the only source of support a student who is far from home has, and the counselor must live up to the professional obligation he has to provide appropriate care and take action to help stop an attempted suicide or a suicide.

A new school year is starting and kids will soon be heading back to college campuses nationwide. For many of these students, the new school year is not something to look forward to this fall. Instead, returning to college mean means a return to the tremendous pressures to be perfect in a competitive college setting. High expectations and intense stress to succeed often contribute to high rates of campus depression and suicidal thoughts among young people.

New York Times reported the rate of death by suicide among 15 to 24 year olds has steadily increased since 2007. And college students may be among the most vulnerable segment of society. A recent survey of college counseling centers found that more than half of clients seeking counseling have “severe psychological problems.” College students, who may have limited parental supervision and distant support networks while away at school, face an especially significant risk. College counselors may be the only ones who can determine when a student is considering death by suicide and the only ones available to take action to help the student. That’s why counselors and academic institutions may be held accountable when these warning signs are missed.

Warning signs are missed by clinicians because of lack of training on taking a systematic suicide assessment.  With training a clinician has no excuse for deciding not to take the time to properly assess and document the assessment.  If the student is at risk for suicide then appropriate interventions need to be taken to protect the patient.

College Students and Risks of Death by Suicide

In 2007, there were 9.6 deaths by suicide per 100,000 individuals age 15 to 24. In 2013, that figure had risen to 11.1 suicides per 100,000 individuals within the same demographic group. Among college students seeking counseling, chances a student would be diagnosed with a severe mental condition increased 13 percent over a period of just two years. Anxiety and depression are the two most common mental health diagnoses among college students.

Female students may be especially at risk of suffering from anxiety and depression because reports have shown many feel a pressure to be effortlessly and relentlessly perfect. This means not only excelling academically and in social endeavors, but also putting forth a persona of being happy and self-assured all the time.

Women afraid to fail may hide mental issues they are facing until it is too late for friends and family to help them. College counselors need to be trained to identify when a student is masking deep-seated depression or anxiety so they can provide the mental health assistance students need when coping with the very real pressures they face.

The Times notes there has been several high profile suicides among both college and high school students in recent years attributed to the culture of high expectations and overachievement. In just 13-months, six students from University of Pennsylvania died by suicide. Tulane University lost four students to death by suicide in a single academic year, and there were three deaths by suicide at Appalachian State. From 2009 to 2010, there were also six students at Cornell University who died by suicide. Most of these students appeared to have everything going for them, and were active in campus groups. However, many were likely responding to pressures to act self-assured and mask doubts they had about their futures.

As college students head back to campus this year, schools need to be aware of the toll of the pressure to be perfect can have on students. That’s why colleges and universities need to make sure students receive the support they need to deal with mental health issues before it’s too late.

A suicide attorney at the Law Offices of Skip Simpson can help. Call (214) 618-8222 or visit http://www.skipsimpson.com to schedule a free case consultation.

More than one million people attempted suicide in the United States in 2013, with total of 41,149 fatal outcomes reported. As the 10^th ranking cause of death in the United States, statistics reveal that an average of 113 people died by suicide every day – or roughly one person every 12.8 minutes.

Sponsored by the American Association of Suicidology, the 41^st annual National Suicide Prevention Week is underway from September 7-13, 2015 and aims to bring a simple message to schools, colleges, hospitals, mental health centers and treatment facilities nationwide: suicide prevention is everyone’s business.

As any mental health malpractice attorney knows, it is critical not only to ensure that those with suicidal ideations and behaviors receive the help they need, but for healthcare professionals of all types to receive the training necessary to identify at-risk patients at schools, colleges, hospitals and mental health centers across the United States.

What is National Suicide Week?

In conjunction with World Suicide Prevention Day on September 10, National Suicide Prevention Week is designed to raise awareness for some of the most common factors for suicide – such as mental illness, substance abuse, previous suicide attempts and access to lethal means – and how to engage individuals and organizations alike to the cause of suicide awareness and prevention.

As part of the campaign, organizations are encouraged to recognize suicide as a significant public health problem. States are encouraged to develop accessible behavioral health service programs, use multiple suicide prevention efforts appropriate for different populations and communities and encourage educational initiatives in schools and colleges.

In addition, National Suicide Prevention Week also encourages high schools, colleges and universities to create activities to educate students about the prevalence of suicide, engage students in prevention activities and promote public awareness about the importance of suicide prevention.

By drawing attention to the critical topic of suicide prevention, the campaign also aims to reduce the negative social stigma surrounding the topic of suicide and encourage the assistance and support of people who have faced suicidal thoughts or attempted suicide. As of 2011, the American Association of Suicidology estimated more than 4.6 million survivors of attempted suicide in the United States alone.

As a means of raising awareness for the issue of suicide prevention, National Suicide Prevention Week observance has a specific theme each year. Past themes have included “Suicide Prevention Across the Life Span” in 2007, “Families, Community Systems and Suicide” in 2010 and “Changing the Legacy of Suicide” in 2011.

A Dallas, TX suicide attorney at the Law Offices of Skip Simpson can help. Call (214) 618-8222 or visit http://www.skipsimpson.com to schedule a free case consultation.

Suicide malpractice attorney Skip Simpson will offer a legal perspective during the 2015 Annual Conference for Behavioral Health on Sept. 17 at the Airport DoubleTree by Hilton.

Simpson, who is based in Dallas but represents families who have lost loved ones nationwide, has been recognized as one of the nation’s leading experts on the legal aspects of suicide. He has been quoted in national publications including the Wall Street Journal and The Atlantic Monthly.

His presentation in September is titled “Thinking Failure – The Right Focus.”  Thinking failure means to imagine all the ways something can go wrong—before it does—and fix it.  Simpson had a 20 year career in the military where he learned about failure mode effect analysis as a combat crew member dealing with nuclear weapons.  NASA, nuclear facilities, and aircraft carrier crews are well versed in the concept.  The Joint Commission for years has stressed that Behavioral hospitals learn to think failure for patient safety.

Simpson will speak about how best practices inform legal protections and reduce risk, among other issues. One of the learning objectives of his presentation is called “Avoiding the fear or lawsuits.”

Simpson urges mental health providers to document their assessments of patients to avoid lawsuits and to reduce the risk of a patient dying.

“My goal as an attorney is not to threaten mental health care providers with lawsuits. I want to help make meaningful systematic changes. The system has been broken for a long time, but it can be repaired and is being repaired” Simpson said. “The law is on the side of care providers; it is not a stumbling block or something to be feared for those who practice safely. If they follow best practices in suicide risk assessment, management and carefully document their assessments and how they reach their conclusions on protecting patients, they will be protected against suicide malpractice lawsuits.”

Over 100 people die by suicide every day in the United States. According to the American Association of Suicidology, 41,149 people lost their lives from suicide in 2013.

Simpson notes that every suicide in a system is preventable. That’s why it’s critical for health care providers to do everything possible to prevent system failure.

“Families are not looking for someone to blame when someone dies by suicide,” Simpson said recently. “Lawsuits often happen when the family is upset and providers aren’t sharing information. What stops lawsuits? In most cases, good documentation, the provider’s explanation for what went wrong, along with an apology. Compassion goes a long way to avoid litigation.”

The conference is presented by the Association of Community Mental Health Centers of Kansas and Kansas Association of Addiction Professionals. For more information about the conference, visit http://www.acmhck.org/annual-conference/.

Over the past 18-months, there have been reports of a dozen cases involving suicide of white-collar workers who were employed by high profile financial firms at the time of their death. Overall, rates of death by suicide are generally lower among those with attained higher levels of education. However, depression can affect anyone no matter what his or her education levels and income bracket. Often, it is more difficult to recognize or respond to signs of suicidal ideation in those who appear, on paper, to have it all. This can make it more difficult to spot and prevent suicide risks among white collar workers and people in privileged positions.

Mental health counselors should know of all signs of suicide in all patients, including those with good jobs and advanced levels of education—the so called VIP patient. When a mental health professional misses signs of suicidal behavior and death by suicide occurs, a suicide attorney should be consulted by surviving family members for assistance. The death of a white collar professional can have serious financial reverberations on family financial stability and mental health professionals should provide compensation to dependents if the negligence of mental health professionals played a role in causing the death by suicide. If clinicians are not familiar with the VIP risk factor, they need to get familiar ASAP.

Why are More White Collar Workers at Risk of Death by Suicide?

Market Watch discussed the recent spate of suicides among financial professionals and considered why suicide rates are rising among white collar workers. Studies have demonstrated doctors, dentists, financial workers, veterinarians, lawyers, and engineers are among the professions with suicide rates at least 1.5 times the suicide rates among the rest of the population .  Physicians have a suicide rate 1.87 times higher than the rest of the population, and dentists have a suicide rate 1.67 times higher than average. A part of this may be explained by easier access to dangerous pharmaceuticals that could be used in a suicide attempt.

Workers within these and other white collar professions may feel significant amount of career pressure. Many of the professions are highly competitive and workers within certain fields may have a particularly negative response to stress or to a crisis. While there has not been a clearly-established causal link between work pressure and higher risks of suicide for white collar professionals, it is possible the high levels of stress coupled with the intensive work environment are a contributing factor to more white collar workers taking their lives.  Careers that are all-consuming may also isolate workers from family and friends, thus increasing the risk of death by suicide.

A spokeswoman for the Centers for Disease Control and Prevention indicated the increased rate of suicide among individuals in these higher-profile and higher-paying careers is something which should be researched further. If a causal link is discovered between certain careers and an added risk of death by suicide, more actions can be taken to protect workers within that field.

National suicide malpractice attorney Skip Simpson says problems highlighted in news reports about Rutland Medical Health Services in Montpelier, Vermont, serve as a reminder that facilities around the country must take all steps to ensure the safety of patients – and now!

“Until there is a culture of safety instead of a culture of making a profit at the expense of safety nothing will change,” said Simpson.

Simpson commented on a July 11 Associated Press story published in the Rutland Herald and other publications (“Lawmakers hear of problems at Rutland Mental Health”). According to the article, Rutland Mental Health Services may close because of a pattern of deficiencies. These include improper use of restraints and failure to lock up medication. One client of the facility who had been on a waiting list for treatment for six months died by suicide.

“As an attorney who has represented families who have lost loved ones because of negligence by healthcare facilities, I see these types of patterns at other facilities across the country,” Simpson said. “I do hope that legislative efforts can lead to improvements. Often, a state is slow to react when a pattern of deficiencies comes to light.

“My job is not to file frivolous lawsuits against these facilities. I want to see healthcare providers do a better job of protecting their clients. Unfortunately, the mental health industry often is resistant to making changes that will improve safety and protect their clients. As a last resort, a lawsuit sometimes is necessary.”

In Montpelier, legislators have recommended that Rutland Mental Health Services be removed from its position as the Rutland region’s main provider of mental health services. According to the AP report, some members of the House Human Service Committee expressed alarm that the state had not acted more quickly to a series of abusive, life-threatening situations, including the suicide of a client.

Simpson said suicide is the third leading cause of death for young adults and the 10^th leading cause of death for the general population.

According to the most recent statistics from the American Association of Suicidology, in 2013 41,149 people in the United States died by suicide.  That statistic breaks down to 112.7 per day.

The AAS states that Vermont ranks 10^th nationwide in terms of suicides. There were 112 deaths in 2013, or a rate of 17.9 deaths per 100,000 population.