Treatment of Suicidal Patients in Managed Care

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Suicide remains all too common in the United States. As the ninth leading cause of death -- responsible for 30,000 deaths annually -- it is also one of the more preventable causes of death

Increasingly, mental health clinicians must care for suicidal patients within managed care systems. Managed care's cost-driven focus on rapid assessment and triage, narrowly restrictive hospital admission criteria, and abbreviated inpatient stays have resulted in poorer clinical care and increased opportunities both for adverse outcomes such as suicide and for clinician liability.

Bringing together a unique mix of clinicians, authorities, and administrators from private practice and managed care, Treatment of Suicidal Patients in Managed Care offers practical guidance on how to improve care and reduce risk for suicidal patients. Contributors explore a wide range of topics: • Hospitalization -- Emphasizes the increased importance of the initial assessment when managed care systems shorten or deny hospitalization for suicidal patients and of knowing whom to call within the managed care system. Includes alternative programs from acute residential care to cognitive-behavioral strategies and dialectical behavior therapy for the suicidal patient in crisis• Suicide risk among adolescents and the elderly -- For adolescents, emphasizes the value of multiple levels of care when admissions are too short and too often followed by distressing and costly readmissions. For the elderly, offers preventive interventions for primary care physicians who are uncomfortable discussing depression and suicidal ideation and intention with their elderly patients• Suicide and substance abuse -- Details the role of case managers in providing continuity of care in a disorder known to be chronic and relapsing• Pharmacotherapy of depression and suicidality -- Discusses the effects of managed care and raises questions about the expertise of the prescriber, especially relevant now that more primary care physicians are treating patients with uncomplicated unipolar depression• Risk management issues -- To counter the perception that managed care companies profit from withholding care, emphasizes the crucial importance today of documenting the reasons for treatment decisions• Helping those affected by the aftermath of a suicide -- A step-by-step process: 1) anticipating a suicide, 2) announcing or sharing the news of a suicide, 3) assessing those affected by a suicide, and 4) seeing what can be learned from reviewing the patient's treatment

This clinical guide will aid understanding of clinical, administrative, and risk management issues relevant to the care of suicidal patients. Psychiatrists, psychologists, nurse clinical specialists, social workers, administrators, and primary care physicians will also rely on it as they cope with the mounting pressures of managed care while maintaining the quality of their care for these vulnerable and patients.

American Psychiatric Publishing

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Editorial Reviews

Doody's Review Service
Reviewer: John K. Larson, MD (Rush University Medical Center)
Description: This surprisingly comprehensive and provocative book on treatment of suicidal patients in an era of managed care contains nine chapters by a group of clinicians and one attorney.
Purpose: This book is intended to meet the need for a thorough overview of the topic of suicide assessment and prevention including philosophical, theoretical, ethical, legal, and professional issues. It is meant to provoke critical thinking, discussion, and ultimately to inform our decisions regarding the care of patients at risk for suicide, especially in an era of increased fiscal constraint.
Audience: The primary audience includes mental health professionals with a desire to explore the topic in some detail along with medical students, residents, and other mental health professionals in training. Attorneys practicing in mental health related fields also will find the book enlightening.
Features: The tone is set in the foreword, which outlines the apparent tension between advocacy for our patients and the increasing demands to provide care in the most cost-effective fashion possible. The foreword is followed by nine uniformly well-written chapters that include an overview of contemporary practice, the use of brief hospitalization and alternative levels of care, suicidal adolescents, suicide in the elderly, co-morbid substance abuse, treatment issues, risk management concerns, and assessment of risk. The book is filled with practical advice and contains an appendix with suggestions on getting the most from a managed care organization, which alone is worth the price of the book.
Assessment: This book should find its way into the hands of mental health clinicians of all disciplines and, hopefully, policymakers in managed care organizations. Although specifically addressing issues that arise in managed care settings, the book serves as an excellent review of the topic of suicide risk assessment and management. Any practicing mental health professional will benefit from a careful reading of this well-written book.
In these nine chapters, psychiatrists, social workers, doctors, lawyers, and nurses discuss the treatment of suicidal patients in a managed care setting. Specific topics include crisis care, brief hospitalization, alternatives to hospitalization, suicidal adolescents, suicide in the elderly, substance abuse, psychiatric pharmacotherapy, risk management, and the aftermath of suicide. Appendixes address the formulation of suicide risk and the ways to get managed care organizations to meet patients' needs. Annotation c. Book News, Inc., Portland, OR (

3 Stars from Doody
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Product Details

  • ISBN-13: 9780880488280
  • Publisher: American Psychiatric Publishing, Incorporated
  • Publication date: 1/28/2001
  • Edition description: New Edition
  • Pages: 240
  • Product dimensions: 6.00 (w) x 9.00 (h) x 0.60 (d)

Meet the Author

James M. Ellison, M.D., M.P.H., is Associate Clinical Professor in Psychiatry at Harvard Medical School, a consultant to The Cambridge Hospital Psychiatry Department, and Interim Clinical Director of Geriatric Psychiatry at McLean Hospital in Belmont, Massachusetts. He is also President of the Northeast Affiliate of the American Foundation for Suicide Prevention.

American Psychiatric Publishing

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Table of Contents

Foreword. Treating suicidal patients in the managed care environment. Managed crisis care for suicidal patients. Managed care, brief hospitalization, and alternatives to hospitalization in the care of suicidal patients. Suicidal adolescents in managed care. Suicide in the elderly. Substance abuse and suicidal behavior in managed care. Psychiatric pharmacotherapy, suicide, and managed care. Risk management issues for clinicians who treat suicidal patients in managed systems. In the aftermath of suicide: needs and interventions. Appendix A: The formulation of suicide risk. Appendix B: Getting more of what is needed from your patient's managed care organization. Index.

American Psychiatric Publishing

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