“I have worked with a patient for several months and there has been little progress treating a trauma history and anxiety. He is obsessed with suicide, saying he has the right to take his life and he refuses to call me or a crisis line when acutely suicidal. I feel stuck. I’m afraid of losing him to suicide and I’m sure his family will blame me and sue me for malpractice. What do I do about this impossible case?”

Anxious providers routinely seek my consultation when feeling “blackmailed” by a patient’s suicidal risk. As a clinician, treatment researcher, expert in ethics, and as a suicide-related malpractice expert witness, I have written extensively on this topic (Jobes, 2011; 2023). Based on my various experiences, I believe that there is an ethical way to handle such power struggles serving the needs of the patient and provider alike.

In 2022, 16,600,000 Americans had “serious thoughts of suicide” (SAMHSA, 2023) and each day on average 130 will die by suicide. Given these statistics, it is paradoxical and alarming that most mental health providers report being insufficiently trained to effectively handle suicidal risk (Goldstein Grumet & Jobes, 2024). In turn, lack of clinical knowledge often fosters fear-based practices and ineffective clinical care. For example, patients who are suicidal are often briefly hospitalized and/or receive a medication-only approach, and research suggests that these interventions may not be effective and can even increase suicide risk (Jobes & Barnett, 2024).

Susan Stefan (2016), a leading mental health legal scholar, has observed that across healthcare specialties, only behavioral health providers are compelled to force an intervention on a patient to avert their death. She notes that a cardiologist would never force a patient with heart disease to undergo a surgery that they oppose. Indeed, such surgery is always a choice for a patient at risk. However, in sharp contrast, state laws routinely require that a mental health patient deemed to be in “clear and imminent” danger for suicide must be stopped (i.e., police may be needed to help involuntarily commit a person at risk to an inpatient setting). This approach may have........

© Psychology Today