Use of a screening tool in this case may have shown that the program had an organized plan to address suicide risk in these “at-risk” kids. It would have provided tangible documentation that suicide risk was considered and may have yielded an extra layer of defense against the claim that this patient’s suicide attempt was foreseeable. Most importantly, the tool may have actually saved the patient’s life by revealing his pain and suicidal thinking.
We have yet to discuss the most unusual aspect of this case: the use of morning glory flower seeds as a drug of abuse. Morning glory seeds contain LSA, which produces an effect similar to LSD. Generally, the user crushes or chews the seeds or extracts the LSA by soaking them in cold water. On consumption, the user experiences LSD-type hallucinations and may experience agitation, anxiety, and mood disturbances, including depression. Apparently, the jury was not persuaded that the morning glory seed abuse caused the patient’s suicide attempt.
In conclusion, take suicide seriously. Have a plan to manage at-risk patients. Document your concern, evaluation, and findings. Consider implementing a suicide screening tool in your practice to ensure the proper questions are asked, answered, and documented. —DML
REFERENCES
1. CDC. Suicide: facts at a glance (2012). www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.pdf. Accessed November 6, 2013.
2. Simpson S, Stacy M. Avoiding the malpractice snare: documenting suicide risk assessment. J Psychiatr Pract. 2004;10(3):185-189. www.reidpsychiatry.com/columns/Stacy%2005-04.pdf. Accessed November 15, 2013.
3. Posner K, Brown GK, Stanley B, et al. The Columbia–Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168:1266-1277.