Suicide is the second leading cause of death among young people between the ages of 15 to 24 in the United States. According to the American Association of Suicidology, more than 5,000 young adults and teenagers in this age range die by suicide each year. Unfortunately, teen depression is not understood as well as it should be and treatment methods – including inpatient treatment – are not always effective at providing young people with the services and support that’s necessary.

When a teen receives inpatient or outpatient care and still takes his or her own life, it is important to determine if the mental health counselors or care providers lived up to their duties as required by law. A failure to provide appropriate care and to perform a proper suicide assessment can result in a claim against any care provider, while inpatient facilities can also be held accountable for failure to adequately  monitor patients to prevent death by suicide.

Inpatient and Outpatient Treatment Must Help Teens Fight Suicidal Ideation

Argus Leader recently took an in-depth look at the problem of teen suicide, sharing the story of a 17-year-old who took her own life after a lengthy battle with depression. The young woman was a volunteer and mentor to others who took dual credit classes and who planned to attend university in the fall. Unfortunately, her family had a history of mental illness and the young woman began to develop depression after a move and after her parent’s divorce when she was in the fifth grade. She was also a victim of bullying in school, and she began cutting which is a common coping measure for teens who struggle to deal with emotional pressure. She also attempted suicide in fifth grade, and was hospitalized in an inpatient treatment facility.

She ultimately would make several more suicide attempts and be hospitalized at the same inpatient facility several times before dying by suicide.  She received a variety of different treatments, including transcranial magnetic stimulation, which is a relatively new depression treatment aimed at stimulating nerve cells in the brain using magnets. Unfortunately, the treatment efforts were not successful and she died by suicide this year.

Her story is similar to the struggles endured by many other teens, who care providers often do not understand how to treat effectively. Efforts are underway to improve the care young people receive, and 20 states have now adopted the Jason Flatt Act to require public school personnel to complete required training on youth suicide prevention and awareness.

Awareness is important, but can only go so far if the teens who are identified as being at risk are not provided with treatments that make a difference in their depression. Unfortunately, if mental health care providers and inpatient treatment centers do not develop more effective ways of treating and preventing teen suicide, tragic deaths of young people will  continue to occur.

Identifying people at risk of suicide is an essential step to providing these patients with the care they require.  A new study shows care providers in the emergency room have an important role to play in identifying people at risk; this is yet another study stating the obvious.  Healthcare professions in an ER setting must do their part to ensure patients are identified so they can receive appropriate care. If not, an attempted suicide may occur within minutes to hours of an unthoughtful disposition.

ER Nurses Can Help Identify Patients at Risk of Death by Suicide

NewsWise reported on the recent study showing the important role emergency room caregivers can play in preventing a suicide. The research was conducted by UMass Medical School.  Researchers discovered when emergency room nurses conducted a universal suicide risk screening, almost double the number of at-risk patients were identified. At-risk patients included those who were positively identified as thinking about suicide or patients with attempted suicide.

The study spanned a five year period. During this time, there were 236,791 visits to emergency rooms included in the study. Suicide risks screenings performed on patients increased from 26 percent to 84 percent of patients undergoing screening over the study period. This increased the rate of detection of suicide risk from 2.9 percent to 5.7 percent.

The suicide screening performed in the emergency room was simple. Nurses in the ER departments were trained to administer a brief questionnaire to patients focused on three risk factors for suicide: depressive symptoms, lifetime attempts to die by suicide, and active suicidal ideation.

Patients were identified as having a positive screen if they had either confirmed they have active suicidal ideation or if they had attempted to die by suicide within six months of the time of the visit to the emergency department.  With this screening process, a subset of patients was identified whose risk of suicide was serious enough the patients needed inpatient psychiatric treatment. Other patients were identified who needed additional evaluation and intervention resources such as a self-help safety card and information about a suicide prevention lifeline.

The lead author of the study indicated: “Our study is the first to demonstrate that near-universal suicide risk screening can be done in a busy ED during routine care. The public health impact could be tremendous, because identification of risk is the first and necessary step for preventing suicide.”  The lead author is correct and we applaud the entire team performing the research.  We hope that the study is transformed into action in the emergency departments and the study is not just a group soliloquy among academics.

No further efforts to help identify risk of suicide in emergency departments are needed at this time.  This need has been answered by the Suicide Prevention Resource Center last year, 2015.  Skip Simpson highly recommends the outstanding work produced by the SPRC: “Caring for Adult Patients with Suicide Risk: A Consensus Guide for Emergency Departments.”  This important work (the ED Guide) is designed to assist emergency department (ED) providers with decisions about the care and discharge of patients with suicide risk.

When patients seek either inpatient care or outpatient treatment for mental illnesses including depression, the treatment they receive is often inadequate. Depression is one of the greatest risk factors for suicide, especially among severely depressed patients who are hospitalized due to suicidal ideation. Unfortunately, even in inpatient settings where patients are supposed to receive treatment from consummate professionals, mental healthcare providers are often left guessing, because of poor training, on what treatments will be effective with no actual scientific method of helping patients.

Scientific America calls the current approach to treating mental illnesses, including depression, the “shotgun approach,” and describes the shortcomings of this treatment method. The term refers to the fact psychiatrists often try many different types of medications in a very imprecise manner.

When patients receive inpatient treatment or outpatient treatment and the wrong medications are provided to treat depression, some of these medications can actually increase the risk of suicide- especially if patients end up having to stop taking the drugs and going through a withdrawal process. Mental health professionals may sometimes be held accountable for the harm their failed treatment efforts can cause, including when a patient attempts to die by suicide. This is especially true in an inpatient setting where care providers should quickly be able to identify when a medication is doing more harm than good.

Improving Mental Healthcare in Inpatient and Outpatient Settings To Prevent Death by Suicide

Centers for Disease Control and Prevention list a history of mental disorders, and particularly clinical depression, as among the top risk factors for suicide. Unfortunately, while there are many medications to treat mental disorders, a trial-and-error approach is usually taken to decide which of these different drugs to try.

Scientific America gives an example of one patient who had been in and out of intensive psychiatric care over close to two decades. She had been diagnosed with bipolar disorder and had experienced periods of suicidal depression.  She had been prescribed antipsychotics, antidepressants, anticonvulsants, mood stabilizers, and anticonvulsants. She had also undergone group and individual therapy, cognitive therapy, and behavioral therapy- but none of the treatments received had made any lasting impact.  The medication she’d been prescribed did lots of different things, from blocking dopamine to focusing on norepinephrine.

Her story was common, as mental illnesses are frequently treated based on guessing which medications will affect observable symptoms, rather than based on getting a correct diagnosis of an underlying cause and treating that specific condition. Genetics and brain imaging in the future could provide clearer answers regarding what is actually going wrong in the brain structure or brain function so more accurate treatments could be provided, and there has been extensive research in this area. Unfortunately, there are continued challenges in finding common markers within different diagnoses.

While treating with medication and experimenting with different drug therapies is challenging and imprecise, it is likely to be the most common method of providing care until research advances. When a patient is in an inpatient setting and different medications are being experimented with, it is imperative for care providers to ensure they are monitoring the effects of medication and are alert for any potential risk of suicidal ideation.  When nothing is working,  Electroconvulsive therapy (ECT) should quickly be considered and carefully explained to the patient and the patient’s family.

Montana universities are taking steps to address suicide epidemic

At the first ever Montana Suicide Prevention Summit last month, advocates for suicide prevention called for mental health and emotional education for the general public, starting at the grade school level.

Marny Lombard, the mother of a Montana State University student who died by suicide in 2013, and Karl Rosston, the suicide prevention coordinator for Montana’s Department of Health and Human Services, were among the key speakers at the summit. Both emphasized the need to prepare ordinary people to recognize and appropriately address suicide risk factors rather than relying exclusively on mental health professionals.

Montana has the nation’s highest suicide rate, nearly double the national average. Every other state in the Rocky Mountain region is close to the top as well. And while some suicide risk factors, such as altitude, are geographically fairly unique to the Rockies, most hold significance nationwide.

Rosston cited several suicide risk factors common in Montana and the surrounding states, including social isolation, easy access to firearms, high rates of alcohol consumption and a social stigma against mental illness. Many people in the West, particularly men, are uncomfortable seeking professional help for depression or emotional health – and that’s true in other parts of the country as well.

That means friends and family must play a key role in encouraging, supporting and protecting people at risk of suicide. Lombard pointed out that at-risk college students are much more likely to turn to their friends than professors or mental health professionals.

Friends and family members can help to prevent inpatient suicide

Even in cases where at-risk persons are already receiving professional help, friends and family play a hugely important role in preventing suicide. The unfortunate reality is that many mental health professionals lack the training and experience to recognize and appropriately address the warning signs that a person is at risk of death by suicide.

Friends and family members who know a person’s interests, background and personality are especially well-equipped to recognize early signs that a person may be at risk. Even when mental health professionals have the necessary training – and, again, many do not – there is no substitute for actually knowing the person.

Relatives and close friends of people in inpatient care need to be their advocates and their support system. Frequent visits and phone calls not only reduce the feeling of isolation that leads to many suicides, but also provide opportunities for loved ones to recognize those warning signs and work with caregivers to appropriately intervene.

Unfortunately, many mental health professionals fail to take appropriate steps to help patients at risk of suicide, even when they are warned of the danger. When that happens, friends and family members with some training in mental health are well-equipped to hold negligent caregivers accountable.

Skip Simpson has a couple of recommendations to understand what a friend or loved one can do to better understand how to help.  First, obtain training from the QPR Institute. There are three steps anyone can learn to help prevent suicide: Question, Persuade, and Refer.  See https://www.qprinstitute.com

Also, there is a quick read called “The Suicide Lawyers: Exposing Lethal Secrets” wherein Skip Simpson and his then partner were interviewed about what Skip Simpson had learned in his years of litigating suicide cases. Skip heard many clients say after starting litigation “if I had only known.” Skip Simpson wanted everyone to know what to look for and what to do before tragedy hit a friend, loved one, business colleague or anyone.

Zero Suicide represents a commitment to identify, protect, and treat people who are at risk of suicide. Central to this commitment is the ability to record and properly share accurate information about a patient’s history and treatment. Without this information, each clinician that treats a patient must start from scratch — an inefficiency that will frustrate health care providers and patients, as well as affect the quality of care. Careful documentation also allows us to understand how health care systems can be improved and patient care made more effective.

The documentation essential to Zero Suicide has another benefit. It can protect clinicians and institutions from malpractice suits. Suicide is the most common cause of legal action against mental health care professionals. The central issues in most suicide malpractice cases are whether the clinician should have anticipated the risk of suicide and whether he or she provided care appropriate to this risk. Showing that a clinician met the standard of care appropriate for suicide risk can stop a malpractice suit in its tracks. Patient care should be documented in real time. Juries may suspect that medical records created after the fact rather than during treatment are inaccurate or self-serving.

Assessments of suicide risk should be carefully documented. It is a fundamental principle of good practice that risk assessment is more than simply using a screening instrument—clinical observation and judgment are also essential. These observations should be documented in the patient’s medical record. Patient responses to questions about suicide and self-harm should be recorded in their own words, and quotation marks used to clearly distinguish which statements represent clinical judgments and which are verbatim reports of what a patient said.

Embarrassment and anxiety can make patients reluctant to admit they are thinking about suicide. They may want to protect family secrets about substance abuse, mental health disorders, sexual abuse, or family violence. They may be in denial or afraid of being institutionalized or feel that no one can help. Involving family members can be crucial to accurately assessing a patient’s risk and making care decisions. Family members can provide information that the patient can’t—or won’t—and this information should be carefully recorded. It should also be noted if family members cannot be reached or are uncooperative. If a suicide results in a malpractice suit, it is the family that will sue. Accurate information about the family’s involvement—or lack of involvement—in patient care can be critical to the outcome.

The clinician should also document the decisions made while developing a patient care plan, how this care plan was implemented, and the criteria used to decide the steps needed to preserve the patient’s safety (such as whether the patient admitted to actively planning his or her suicide and whether the patient has access to firearms).

It is also important for the clinician to document his or her review of medical records and consultations with other service providers. If medical records or prior providers are not available, all attempts to obtain records and reach providers should be documented.

Focusing on the possibility of malpractice lawsuits turns the clinician’s attention away from the patient to him- or herself. Thoroughly and accurately documenting the assessment and care of patients who may be at risk of suicide will help deter malpractice lawsuits as well as contribute to quality care, patient safety, and the ability of clinicians and the health care system to work toward the goal of zero suicides.

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Virginia governor Terry McAuliffe’s plan to close Catawba Hospital, a 110-bed psychiatric facility located near Roanoke, is the latest blow to the state’s underfunded and uncoordinated mental health system.

Over the past four decades, Virginia has already lost nearly 80 percent of its psychiatric hospital beds, leaving fewer than 1,500 statewide. Compounding the problem is the lack of community-based services, such as counseling, housing and treatment, needed for people struggling with mental illness to get the care they need outside an inpatient facility.

Due to the state’s failure to invest in those services, hundreds of discharge-ready patients are crowded into a limited number of beds, stuck at a hospital level of care because there is no plan for them to step down. This leaves little room for those who are most at risk.

As a result, people suffering from mental illness and substance disorders are left in a place that is ill-equipped to care for them: the criminal justice system. Nearly 7,000 Virginians with mental illness are currently incarcerated, more than four times the number in psychiatric hospitals.

Lack of Services Leads to Tragedy

Without the dedicated care they need, inmates with mental illnesses are at increased risk of abuse, neglect and suicide. In one recent tragedy, Jamycheal Mitchell, a mentally ill 24-year-old man, was arrested after shoplifting $5 worth of snacks from a convenience store. He wasted away and died after four months of neglect in jail.

A judge repeatedly ordered that Mitchell be transferred to a psychiatric hospital, but no beds were available. Meanwhile, at Eastern State Hospital, the nearest state psychiatric facility, some two dozen patients had been designated ready for discharge but remained in their beds due to a lack of community-based services.

Even when beds are available, failures to effectively coordinate care can be deadly. In November 2013, Austin “Gus” Deeds, a 24-year-old college student with bipolar disorder, stabbed and slashed his father, R. Creigh Deeds, 13 times before dying by suicide.

That night, the Deeds family had gotten a court order that gave the state six hours to place Gus in an inpatient treatment facility. Mental health evaluator Michael Gentry claimed he called 10 facilities that could care for Gus, but phone records show that he only called seven. Tragically, two of the three facilities that were not called had space available.

The elder Deeds, a Virginia state senator, survived the attack and has been a vocal advocate for mental health reform since. He is also pursuing a $6 million wrongful death suit against the state.

A Nationwide Trend

Virginia’s issues with mental health are far from unique. Rather, the lack of psychiatric beds is a result of a nationwide initiative in the 1970s to downsize psychiatric hospitals in favor of community-based care. While well-intentioned, this initiative ultimately led to cuts across the mental health system, as funding did not follow the patients into the community.

As such, people suffering from mental illness and their loved ones are left to deal with confusing bureaucracy, long wait times for services, overcrowded facilities and overworked care providers. In such environments, patients are commonly neglected and even abused, leaving them at elevated risk for inpatient suicide.

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.

In 2013, there was a significant increase in the number of young people who used a firearm to die by suicide. Most of the instances in which a young person died by suicide using a gun involved a family member’s firearm.

A suicide attorney knows that many people who are considering death by suicide will use a firearm when available. This is one reason why it is so important for mental health counselors and professionals to be aware of the signs of suicide and to take action. Family members who are warned that a loved one is considering death by suicide can take extra precautions with any weapons in their home.

More Deaths By Suicide Involve Firearm Use

According to NBC News, the number of teens who died by suicide involving a firearm reached a 12 year high. An estimated 876 young people between the ages of 10 and 19 took their lives using firearms.

This is the third straight year in which the number of young people who chose this method to die by suicide has increased. In approximately 82 percent of situations where a young person died by suicide involving a firearm, the gun belonged to a parent or to another family member.

The increase comes at the same time as a general spike in the suicide rate for teens. Death by suicide is now the second leading cause of teen fatalities, with only motor vehicle accidents causing more fatalities. From 2007 to 2013, the overall rate of suicide among young people between the ages of 10 and 19 increased by as much as 34 percent.

Some advocates of stricter weapons laws argue that guns in the home increase the chances that a child will be shot and killed. A study published in the Annals of Internal Medicine also asserts that having access to guns increases the risk of death by suicide and Fox News indicated that guns in the home could cause as much as a three-fold increase in the risk of death by suicide.

Access to firearms may result in a high number of deaths by suicide not just because people who are considering suicide may find it easier if a gun is available, but also because guns tend to be a speedy method of suicide as compared to other things like taking pills. There is less opportunity for help to come or for a young person to change his mind when a gun is used in an attempt to die by suicide.

Health care professionals need to carefully monitor young people, and people of all ages, for risks of suicidal tendencies. If a young person seems especially at risk of suicide, it becomes important to discuss options with family about restricting access to weapons as well as about getting appropriate care.

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.

Nearly  everyone has heard about the importance of talking about your problems and not keeping feelings bottled up. A new study in Lancet Psychiatry finds that talking to others – specifically, therapists – can actually save lives. People who have attempted suicide can benefit from “talk therapy,” another name for psychotherapy. Repeat suicide attempts and deaths by suicide were about 25 percent lower among a group of Danish people who underwent voluntary short-term psychosocial counseling after a suicide attempt, according to the study.

Researchers from Johns Hopkins Bloomberg School of Public Health examined Danish health data from about 65,000 people who attempted suicide between Jan. 1, 1992, and Dec. 31, 2010. They looked at 5,678 people from that group who received sessions of talk therapy at one of Denmark’s eight suicide prevention clinics. Then they compared their outcomes over time with more than 17,000 other people who attempted suicide and who looked similar on other factors but had not gone for treatment afterward. Analyzing the data after a 20-year follow-up, researchers found the people who received talk therapy  were less likely to attempt suicide than people who did not receive the therapy.  Those who received psychotherapy repeated acts of self-harm less frequently and had a lower risk of death by suicide (or any cause) than those in the study who did not receive the therapy.

First-Of-Its-Kind Study Supports Benefits of Psychotherapy in Suicide Prevention

Suicide attorneys understand that it’s no surprise that counseling people with suicidal thoughts will help save lives.  But up until now, there has not been a lot of research to support whether a specific treatment is working. It’s a difficult subject to analyze, according to the study’s authors, because it’s not ethical to conduct a randomized study where some people get suicide prevention therapy while others don’t. In Denmark, the suicide prevention clinics were rolled out slowly and participation in the study was voluntary. Researchers say the large-scale study is the first of its kind to offer evidence that talk therapy can decrease the number of deaths by suicide.

Unfortunately, we know that many licensed mental health professionals in the United States lack proper training to help people who are at risk. They sometimes fail to offer the talk therapy – or other types of treatment – that can save lives. That’s why families whose loved ones died by suicide need the help of experienced attorneys who know what’s required to hold mental health providers accountable.

The new study was detailed in many publications, including a report in Time on Nov. 24, 2014. Quoting researchers, Time stated: “People who present with deliberate self-harm constitute a high-risk group for later suicidal behavior and fatal outcomes, so preventive efforts are important; yet, implemented specialized support after self-harm is rare.”

In  Johns Hopkins Bloomberg School of Public Health news release about the findings, Annette Erlangsen, DPH, an adjunct associate professor in the Department of Mental Health, stated: “We know that people who have attempted suicide are a high-risk population and that we need to help them. However, we did not know what would be effective in terms of treatment. Now we have evidence that psychosocial treatment – which provides support, not medication – is able to prevent suicide in a group at high risk of dying by suicide.”

According to the news release, researchers suggest broadly implementing therapy programs for people who have attempted suicide in the past.

We have no doubt that there’s room for improvement when it comes to helping people who have made attempts at suicide or who have suicidal thoughts. We hope this new study will lead to some meaningful changes.

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.

When a person is incarcerated, he or she is still entitled to receive necessary medical care for health conditions. This includes not just physical symptoms but also mental problems that may be causing someone to have thoughts of suicide or to consider dying by suicide. Unfortunately, a recent article on AOL.com suggested that safeguards designed to prevent inmates from harming themselves are not being followed.

Anyone considering dying by suicide deserves to get help and have a chance to recover, even if that person is in jail or prison. This “prisoner,” by the way, may be a teen locked up in jail for a DWI; a teen who is ashamed for the arrest and thinking he or she has ruined their life.  Of course they haven’t but they think so.

Those responsible for providing help can be held accountable if they negligently fail. An experienced suicide attorney can represent victims or family members who suffer as a result of a failure of healthcare providers or other professionals.

Inmates at Risk of Death by Suicide

According to AOL.com, an inmate in New York city who was experiencing mental illness died by suicide. He had attempted to die by suicide three times within a three day period of time before his ultimate death. As a result, he was put on 24-hour watch in an attempt to protect him. This was ignored. Also ignored was a screening form in which he had indicated that he was “thinking about killing himself.”

This is not an isolated incident. Another inmate also died by suicide in a solitary confinement cell after telling the guards that he was suicidal. When he said this to one of the guards shortly before his death, the reply was to “go ahead and do it,” if you have the courage to do so. A third story involved another inmate dying by suicide using a metal bed that he stood on its end to create a scaffold. The beds were supposed to be welded to the floor to prevent this, since another inmate had previously done the same thing.

AOL reported that records show at least 11 suicides in New York City jails in the past five years. In at least nine of the incidents, there was a failure to follow safeguards designed to prevent inmates from death by suicide.

Problems include:

• Communications breakdowns between guards and mental health staff, which can sometimes result in inmates not getting necessary medications or precautions not being taken to protect those considering death by suicide.
• Improper distribution of medication.
• Inadequate mental health treatment.

There is no excuse for these types of problems, but they happen all the time. As a result, after cancer and heart disease, suicide is the third leading cause of death in jails nationwide. Throughout the country, there are 41 deaths by suicide among inmates for every 100,000 people incarcerated.

It is often possible to prevent death by suicide and a failure to take reasonable precautions to protect inmates can be considered negligent. When someone’s negligence directly contributes to a death by suicide, it is important to hold that individual or company accountable in order to change behavior going forward in the future and provide broader protections to those who need them.

A suicide attorney at the Law Offices of Skip Simpson can help. Call (214) 618-8222 to schedule a free case consultation.