From the Guidelines
The protocol for a patient who discloses suicidal thoughts to a social worker but denies them to a doctor requires immediate safety assessment and intervention, prioritizing the patient's safety above all else. The patient should undergo a comprehensive suicide risk assessment by a qualified mental health professional, evaluating risk factors, protective factors, and the nature of suicidal thoughts, as recommended by the American Psychiatric Association 1. This assessment should include an evaluation of the patient's current suicidal ideas, suicide plans, and suicide attempts, as well as their access to suicide methods, motivations for suicide, and reasons for living 1.
Key Components of the Protocol
- Document the discrepancy between the patient's disclosure to the social worker and their denial to the doctor, and treat the disclosure of suicidal ideation as valid regardless of later denial
- Implement appropriate safety measures based on risk level, which may include voluntary or involuntary hospitalization for high-risk patients, safety planning for moderate-risk patients, or close outpatient follow-up for lower-risk patients
- Maintain confidentiality except when necessary for patient safety
- Use evidence-based screening tools, such as the Patient Health Questionnaire-9 (PHQ-9) item 9, to identify suicide risk, as supported by studies 1
- Consider using crisis response planning, dialectical behavior therapy (DBT), or problem-solving therapy, which have been shown to be effective in reducing suicidal ideation and behavior 1
Importance of a Multidisciplinary Approach
A multidisciplinary approach involving both the social worker and physician is essential, as patients may disclose different information to different providers based on their comfort level or therapeutic relationship. The patient's denial should not be taken as absence of risk, as suicidal ideation can be intermittent and patients may minimize symptoms. By prioritizing the patient's safety and using a comprehensive and evidence-based approach, healthcare providers can effectively manage patients at risk for suicide and reduce the risk of suicidal behavior.
From the Research
Protocol for Suicidal Thoughts
- When a patient reports suicidal thoughts to a social worker but denies them when interviewed by a doctor, the protocol is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, it is essential to note that suicidal thoughts are a serious concern and require immediate attention.
- The study by 2 emphasizes the importance of social workers using methods that are not only life-preserving but also life-affirming when dealing with clients who have suicidal thoughts.
- The other studies 3, 4, 5, 6 focus on the treatment of depression and anxiety disorders using selective serotonin reuptake inhibitors (SSRIs), but do not provide specific guidance on the protocol for handling suicidal thoughts in this scenario.
Importance of Consistent Reporting
- Consistent reporting of suicidal thoughts is crucial for providing appropriate care and support to patients.
- The discrepancy between the patient's report to the social worker and their denial to the doctor highlights the need for clear communication and collaboration between healthcare professionals.
- Further research is needed to develop effective protocols for handling such situations, as the current studies do not provide direct guidance on this topic 2, 3, 4, 5, 6.
Limitations of Current Studies
- The provided studies do not address the specific scenario of a patient reporting suicidal thoughts to a social worker but denying them to a doctor.
- The studies focus on the treatment of depression and anxiety disorders using SSRIs 3, 4, 5, 6, or the role of social workers in suicide prevention 2, but do not provide a clear protocol for handling inconsistent reporting of suicidal thoughts.