Clinicians' perception of risk for liability in suicide assessment

Michael Gerard Henry (1996)

The assessment of suicide is a complex task involving the consideration of many variables. Previous research into the prediction of suicide has focused on patient characteristics in order to increase the efficacy of prediction. This study seeks to document the potential presence and characteristics of a contextual variable in the civil commitment process: the perception of risk for liability (POL). The scope of this study was largely exploratory. The major hypothesis of this investigation stated that a clinician's perception of risk for liability affects his or her clinical practice, especially decisions to commit patients who do not meet legal criteria for civil commitment. This hypothesis was explored via a survey methodology containing two parts: a behavioral analogue component surveying decisions to commit for three patients presented in vignettes who did not meet legal criteria for civil commitment, and; a clinical practice component surveying reports of the impact of liability on day-to-day clinical practice. A qualitative analysis of participants' rationale for the commitment of individuals who do not meet legal criteria was also completed. In total, the decision to commit patients featured in the vignettes occurred over one-third of the time. Perception of risk for liability was cited as influential in commitment decision making, documentation, relationship with patients, effective treatment of patients, and the affective experience of the clinician. Content analysis of the clinicians' rationale for committing patients who did not meet commitment criteria revealed two patterns in decision making: "Responsibility shift" and "decision acquiescence". These findings have implications for clinical practice, education and training, and future research.