Suicide, Psychiatric Malpractice, and the Bell Curve

The long-recognized “risk factors ” of suicide are so fraught with false positives and negatives as to be nearly valueless in anticipating and preventing suicide or suicide attempts in actual clinical practice. Suicide is no more or less foreseeable in the few patients who attempt self-harm than in the many who make no such attempts. Finally, it is difficult to distinguish retrospectively the quality of the psychiatric care provided to patients who attempt or commit suicide from that received by those who do not. Thus, simple chance may be the only statistically meaningful risk factor for these tragic treatment outcomes. J Am Acad Psychiatry Law 32:319–23, 2004 There are two kinds of psychiatrists: those who have had pa-tients commit suicide and those who will.—Robert I. Simon [Ref. 1, p 340] While in midtreatment, a patient takes his own life, apparently providing an essential element of the psy-chiatric malpractice case: treatment ended in catas-trophe. A suit is filed against the psychiatrist, the social worker, the hospital or clinic, perhaps the dru