Legal and Liability Issues in Suicide Care

In a behavioral health setting, liability refers to a legal case of malpractice that can occur if a counselor or mental health professional fails to provide documentation or treatment for a client known to be suicidal. Therapists and other mental health providers treating suicidal patients must do their due diligence and ensure proper screening, risk assessment, pursuit of appropriate treatments and accurate documentation throughout treatment.

Because suicide is one of the leading causes of liability concerns against behavioral health providers, it's crucial to know how to minimize liability and appropriately address suicidal concerns with evidence-based prevention strategies.

If a patient ends their life, the behavioral health professional is liable for a lawsuit. In court, the plaintiff will have to prove that the therapist's omission or act fell below the standard of care required for a suicidal patient, increasing their risk of harm.

Foreseeability, which is the reasonable anticipation a therapist may have that an individual will likely harm themselves, plays a central role in preventing liability and legal concerns. With proper assessment, therapists and counselors can predict a patient's risk for suicide and implement a critical treatment plan.

As a behavioral health provider, there are some crucial areas of concern to avoid a medical malpractice suit when counseling a suicidal patient.

• Evaluate suicide risk at intake and during each session.
• Conduct regular mental status examinations.
• Refer the patient for hospitalization, if necessary.
• Implement safeguards to protect clients from self-harm.
• Establish a formal treatment plan.
• Consider existing suicide risk, the client's history of suicidal ideation or depression and previous suicide attempts.
• Collaborate with the client's psychiatric and medical care team.
• Determine the support system in treatment planning.
• Identify substance use, mood disorders or stressful life events that may increase suicide risk.
• Document each session with the patient and note all referrals, risk factors and behavioral observations.
• Contact emergency services if the client poses an imminent harm risk to themselves or others.

If you are counseling a patient expressing suicidal thoughts, tendencies or intentions, it's your responsibility to be as accurate and thorough as possible in your clinical documentation. Your therapy notes can play an instrumental role in reducing liability risk and ensuring your patient gets the care they need. High-quality documentation that reflects careful and thoughtful suicide assessments also enables you to evaluate your patient's progress and modify your treatment plan as needed.

When a client is a danger to themselves, you may have to share your session notes with their physician, psychiatrist, or family members to prevent self-harm. Your legal right to breach this confidentiality depends on state and federal laws.

For example, in California, Section 56.10(c)(19) of the Civil Code states that a therapist can disclose specifics about their patient if they have good reason to believe it will prevent or reduce the threat of harm. In some states, you also have a duty to report suicidal ideation, even if the client claims they have no intention to harm themselves. Always check with your supervisor and review your state and federal laws for reporting procedures.