This case concerns a 24-year-old woman, Ms. C. She was in a vehicle with her boyfriend (Mr. D) who broke up with her as they were driving. She was intoxicated, made suicidal statements, and tried to jump out of the moving vehicle. Mr. D stopped the car, called 911, and Ms. S was taken to a nearby ED.
This is a fraught area. I think we (EM, society, patients, institutions, etc.) need to have a heart-to-heart about what is desired, where autonomy resides, where do I take away another person's right to do as they like with their body. This conversation will entail a lot of advocating and must include the assets to do what is requested. Telling EM physicians what they have to do then not giving them the resources (financial, legal, time, etc.) is not honest; current demands are childish (actions without responsibility.)
Very interesting here that there's no mention of the social worker or doctor diagnosing the patient with anything (e.g., bipolar, depressed, borderline personality, etc). Certainly, establishing the presence or absence of a major psychiatric diagnosis would be considered relevant to the assessment of safety vs. risk of suicide. A sad but very instructive case, thank you.
I agree with the plaintiff that the suicide evaluation, in this case, was poorly carried out.
No suicide evaluation solely depends on the suicidal subject, especially when there was who initiated the emergency call. Many articles advise against using safety contracts because it is usually meaningless when a patient is determined to commit suicide. Besides, the determination to discharge a patient should include handling the situation when an adverse incident happens again after discharge.
She contracted for safety, denied current suicidal ideation and had a safe place to go. An admission was not justified. Could have used the Mental Health Act but even that would be dubious as it is not the least restrictive method of practice.
I wouldn’t be surprised if there was a prior history of this type of behaviour which would have made her at higher risk of harm from misadventure or suicide.
This is a fraught area. I think we (EM, society, patients, institutions, etc.) need to have a heart-to-heart about what is desired, where autonomy resides, where do I take away another person's right to do as they like with their body. This conversation will entail a lot of advocating and must include the assets to do what is requested. Telling EM physicians what they have to do then not giving them the resources (financial, legal, time, etc.) is not honest; current demands are childish (actions without responsibility.)
Very interesting here that there's no mention of the social worker or doctor diagnosing the patient with anything (e.g., bipolar, depressed, borderline personality, etc). Certainly, establishing the presence or absence of a major psychiatric diagnosis would be considered relevant to the assessment of safety vs. risk of suicide. A sad but very instructive case, thank you.
I agree with the plaintiff that the suicide evaluation, in this case, was poorly carried out.
No suicide evaluation solely depends on the suicidal subject, especially when there was who initiated the emergency call. Many articles advise against using safety contracts because it is usually meaningless when a patient is determined to commit suicide. Besides, the determination to discharge a patient should include handling the situation when an adverse incident happens again after discharge.
She contracted for safety, denied current suicidal ideation and had a safe place to go. An admission was not justified. Could have used the Mental Health Act but even that would be dubious as it is not the least restrictive method of practice.
I wouldn’t be surprised if there was a prior history of this type of behaviour which would have made her at higher risk of harm from misadventure or suicide.