Communicating suicide risk to families of chronically suicidal borderline personality disorder patients to mitigate malpractice risk.

ABSTRACT

OBJECTIVE: The distinction between acute and chronic suicidality is important, because interventions designed to address acute suicidality can worsen chronic suicidality, resulting in an escalating cycle of suicide threats, suicide attempts, and futile hospitalizations. Though most chronically suicidal borderline personality disorder patients improve and do not complete suicide, the potential for suicide contributes to these hospitalizations and a paucity of outpatient services due to treaters' concern over malpractice lawsuits in case of suicide. Communicating with patients' families about the suicide risk has been suggested as a means to mitigate this malpractice risk, but the approach to such communication has not been described. METHOD: Once chronic suicidality is identified, a stepwise approach to communicating with the patient's family is described. RESULTS: The potential benefits of this risk communication are described, for patients, families, treaters, healthcare systems, and health and malpractice insurers. CONCLUSION: It helps to develop an alliance with families and patients around a shared understanding of outcomes in chronic suicidality - most eventually do better, but the risk of completed suicide is real. This enables patients and families to make a more fully informed choice about treatment, which in turn can reduce litigation risk in the minority of cases where the patient completes suicide.