Psychiatry Expert Opines on Patient Suicide While Under Hospital Care

This case involves the suicide of a 15 year old female. The patient began to exhibit tendencies towards self-harm after the death of her mother, and was brought to the hospital for psychiatric treatment by her father. While in the hospital, the patient revealed that she had been experiencing passive suicidal ideations since the death of her mother. As a result, she was placed on medication and sent to a residential treatment center. While at the treatment center, the patient continued to experience suicidal ideation, and was sent to a psychiatric hospital for care. While the patient was under observation at the hospital as a likely suicide risk, the patient hung herself in her room.

Question(s) For Expert Witness

1. If a patient presents to the hospital with constant thoughts of suicide, what would be the typical course of treatment? How would this type of patient be monitored and for how long?

2. If a teenager presents with suicidal ideation, would you prescribe any medication that includes a risk of suicide in teenagers? If yes, under what circumstances?

Expert Witness Response E-040670

If an adolescent has active suicidal thoughts or a plan, inpatient psychiatric treatment is indicated until such time that the patient is no longer at risk. During the initial treatment, it is important to conduct a careful medical and psychiatric evaluation to rule out any underlying medical, psychiatric or substance abuse related conditions. Treatment may need to be implemented, including the use of antidepressant agents if the adolescent meets criteria for a diagnosis of Major Depression, as well as individual and family psychotherapy. In some cases, the prescription of antidepressants may prolong the hospitalization if there is concern about side effects, including a temporary increase in suicidality. Decisions about whether or not to prescribe medications should always include a careful risk-benefit analysis and informed consent. The treatment plan may appropriately include ongoing treatment in a partial hospitalization program or in more severe cases, a residential treatment program. Since many acute inpatient psychiatric facilities offer only short term treatment, it may be necessary to consider transfer to a longer term inpatient facility that specializes in this type of treatment.