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Treatment of Suicidal Patients in Managed Care

Edited by James M. Ellison, M.D., M.P.H.

  • ISBN 978-0-88048-828-0
  • Item #8828

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Suicide remains all too common in the United States. As the ninth leading cause of death—responsible for 30,000 deaths annually—it is also one of the more preventable causes of death

Increasingly, mental health clinicians must care for suicidal patients within managed care systems. Managed care's cost-driven focus on rapid assessment and triage, narrowly restrictive hospital admission criteria, and abbreviated inpatient stays have resulted in poorer clinical care and increased opportunities both for adverse outcomes such as suicide and for clinician liability.

Bringing together a unique mix of clinicians, authorities, and administrators from private practice and managed care, Treatment of Suicidal Patients in Managed Care offers practical guidance on how to improve care and reduce risk for suicidal patients. Contributors explore a wide range of topics:

  • Hospitalization—Emphasizes the increased importance of the initial assessment when managed care systems shorten or deny hospitalization for suicidal patients and of knowing whom to call within the managed care system. Includes alternative programs from acute residential care to cognitive-behavioral strategies and dialectical behavior therapy for the suicidal patient in crisis
  • Suicide risk among adolescents and the elderly—For adolescents, emphasizes the value of multiple levels of care when admissions are too short and too often followed by distressing and costly readmissions. For the elderly, offers preventive interventions for primary care physicians who are uncomfortable discussing depression and suicidal ideation and intention with their elderly patients
  • Suicide and substance abuse—Details the role of case managers in providing continuity of care in a disorder known to be chronic and relapsing
  • Pharmacotherapy of depression and suicidality—Discusses the effects of managed care and raises questions about the expertise of the prescriber, especially relevant now that more primary care physicians are treating patients with uncomplicated unipolar depression
  • Risk management issues—To counter the perception that managed care companies profit from withholding care, emphasizes the crucial importance today of documenting the reasons for treatment decisions
  • Helping those affected by the aftermath of a suicide—A step-by-step process: 1) anticipating a suicide, 2) announcing or sharing the news of a suicide, 3) assessing those affected by a suicide, and 4) seeing what can be learned from reviewing the patient's treatment

This clinical guide will aid understanding of clinical, administrative, and risk management issues relevant to the care of suicidal patients. Psychiatrists, psychologists, nurse clinical specialists, social workers, administrators, and primary care physicians will also rely on it as they cope with the mounting pressures of managed care while maintaining the quality of their care for these vulnerable and patients.


  • Contributors
  • Acknowledgments
  • Foreword
  • Chapter 1. Treating suicidal patients in the managed care environment
  • Chapter 2. Managed crisis care for suicidal patients
  • Chapter 3. Managed care, brief hospitalization, and alternatives to hospitalization in the care of suicidal patients
  • Chapter 4. Suicidal adolescents in managed care
  • Chapter 5. Suicide in the elderly
  • Chapter 6. Substance abuse and suicidal behavior in managed care
  • Chapter 7. Psychiatric pharmacotherapy, suicide, and managed care
  • Chapter 8. Risk management issues for clinicians who treat suicidal patients in managed systems
  • Chapter 9. In the aftermath of suicide: Needs and interventions
  • Appendix A: The formulation of suicide risk
  • Appendix B: Getting more of what is needed from your patient's managed care organization
  • Index

About the Authors

James M. Ellison, M.D., M.P.H., is Associate Clinical Professor in Psychiatry at Harvard Medical School, a consultant to The Cambridge Hospital Psychiatry Department, and Interim Clinical Director of Geriatric Psychiatry at McLean Hospital in Belmont, Massachusetts. He is also President of the Northeast Affiliate of the American Foundation for Suicide Prevention.

Any practicing mental health professional will benefit from a careful reading of this well-written book.—Doody Publishing, 12/1/2001

This is a clinically informed, highly practical book. It suggests many creative, clinically responsible but cost-effective ways of assessing and treating suicidal patients, and provides highly practical guidance on how to deal with managed care companies. The chapters blend clinical experience and wisdom with sharp understanding of how our current insurance system functions. It covers a comprehensive range of topics. Managed care for the suicidal patient has the potential for both great benefit and great harm. This book offers evidence-based suggestions for innovative and cost-effective clinical strategies that build on the positive possibilities that well-managed care can provide. It also offers ample guidance about the dangers and pitfalls of managed care and how to avoid them.—James E. Sabin, M.D., Clinical Professor of Psychiatry, Harvard Medical School, Director, Ethics Program, Harvard Pilgrim Health Care

Treatment of Suicidal Patients in Managed Care is a uniquely valuable resource for all clinicians. It concisely integrates the best thinking on the appropriate management of the suicidal patient by acknowledged experts and the understanding of how to provide this treatment in the climate of managed care. Dr. Ellison's editing brings clarity, organization and compassion to the guidance for clinicians to enable them to get the best possible care for their suicidal patient. The appendix 'Getting More of What is Needed from Your Patient's Managed Care Organization' is a must read for every clinician in training or practice.—Myron L. Belfer, M.D., M.P.A, Professor of Psychiatry, Department of Social Medicine, Harvard Medical School, Senior Associate in Psychiatry, Boston Children's Hospital

Dr. Ellison and his contributors are to be congratulated for juxtaposing two topics that bedevil practicing clinicians and suggesting how they may be reconciled. The essays emerge largely from the managed care setting and are thereby informed, objective in tone, and filled with useful guidance: the 'tips' and appendices in particular will be of value to new and practicing clinicians who must balance patient advocacy with life in the real world. It is, after all, life in the real world that challenges the suicidal patient, and the challenge is no less for us.—Michael J. Bennett, M.D., Associate Clinical Professor, Harvard Medical School

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