INPATIENT STANDARDS OF CARE AND THE SUICIDAL PATIENT .1. GENERAL CLINICAL FORMULATIONS AND LEGAL CONSIDERATIONS

The most common legal action involving psychiatric care is the failure to reasonably protect patients from harming themselves. In this regar d it is critical to understand that courts have tended to impose much stricter standards on inpatient than on outpatient care; that at the p resent time, most malpractice actions involve clinical activities rela ted to inpatient care (negligent admission, treatment, supervision, di scharge, etc.). This article reviews the current climate in the legal and clinical formulation of standards of care for hospitalized adult s uicidal patients. It suggests general guidelines for effective assessm ent, management, and treatment procedures that balance the need for hi gh-quality care by a reasonable and prudent practitioner with the requ irements of court-determined and statutory standards. The authors spec ifically discuss court cases that show common failure situations in in patient care, discharge planning, and follow-up (e.g., problems in pha rmacotherapy, the decision to hospitalize, the assessment of imminence and lethality, etc.). The paper also emphasizes the crucial element o f clinical judgment in developing any inpatient standard of care.