Dear patient threatening suicide

[MillCreek]

I just had an emotional call with a family. Their wife/sister is half-assedly threatening suicidal ideation, and when they take her to the hospital, she denies any ideation or plans to the intake mental health clinician and as such she does not qualify to be held for an involuntary admit under Washington state law.

The family was begging me for more information about her care.  I asked them to put the patient on the speakerphone.  I asked her if she gave her permission to share her psychiatric information with the spouse and sister.  She said no.  And that is all she wrote, from my perspective.  Behavioral health information has a particularly high level of confidentiality attached to it, and there are only a very few circumstances in which I can share that information without the consent of the patient.

The family is heartbroken and begged me to call them back and disclose the information.  I told them that I could not ethically or legally do that, and I fire people for exactly that sort of thing. 

I suspect she is not actually suicidal, but she is sure putting her family through heck.

[Hawkmoon]

If they are convinced that she really is suicidal, can't they go to a probate court and have her committed? Or admitted for evaluation?

My guess is that's what they want to happen, but they don't want to be the bad guys who sign the papers so they want you to do it and let them avoid responsibility.

[BlueStarLizzard]

Hey, at least they seem to still give a *expletive deleted*it.

By the time my mom started threatening to commit suicide, Dad and I were like "Please, go ahead. Please..."

Mental illness doesn't change the fact that abuse is abuse, and people who pull that kind of *expletive deleted*it are abusive. 

[BobR]

Hey, at least they seem to still give a *expletive deleted*it.

By the time my mom started threatening to commit suicide, Dad and I were like "Please, go ahead. Please..."

Mental illness doesn't change the fact that abuse is abuse, and people who pull that kind of *expletive deleted*it are abusive. 

You would make a good nurse. You hear so many times people want to kill themselves sometimes you just wish they would do it and quit showing up on a weekly basis to manipulate people.

bob

[lee n. field]

Family therapy time.

[AmbulanceDriver]

Had a situation years ago when I was an EMT and still in the field. We were dispatched to what sounds like a very similar situation as what you described Millcreek...  Family called because family member is threatening claims to have a plan,.etc... Of course we get there with LE and it's deny deny deny. We were all on scene for close to an hour trying to convince her to come with us to get evaluated... Finally we're packing up leave, she's refused to go with us, and we're heading out the door. I stopped in the atrium at the front door to tie my boot, when I hear clear as day, from the back of the house, "I can't believe you called 911, maybe I really *should* just drink the bleach and get it over with!!!"

Whoops........

Get on the radio to my partner, "Don't let those deputies leave. We're going to need them..."

Walk back towards the back of the house, deputies in tow, "Ma'am, now you are most definitely going to need to come with us tonight."

The temper tantrum she threw was *epic*.

[lee n. field]

. Their wife/sister is half-assedly threatening suicidal ideation,

The family was begging me for more information about her care.  I asked them to put the patient on the speakerphone.  I asked her if she gave her permission to share her psychiatric information with the spouse and sister.  She said no.  And that is all she wrote, from my perspective. 

I'm surprised you can't tell her husband anything.

I suspect she is not actually suicidal, but she is sure putting her family through heck.

Just guessing, but I'll bet everyone around her would be quite relieved if someone else was dealing with her for a while.

[230RN]

I'm surprised you can't tell her husband anything.

...

I wondered about that, too, but wasn't sure on where I stood.  I thought marriage conferred a unity upon the couple, as for example where one spouse can't be compelled to testify against the other one.   Almost as if the pair were actually one person.

On the other hand, you can't send one spouse to jail for the crimes of the other one.  On the third hand, this was over the telephone, which brings up the question of positive identity of the other party... am I really dealing with the actual spouse?

I'm sure that's a legal morass, which is why I didn't mention it.

So y'all can blame lee n. field for bringing it up.

Terry, 230RN

[MillCreek]

^^^Generally speaking, under state and Federal law, certain areas of healthcare have a higher standard of confidentiality attached to them: STI (including HIV), mental health, and substance use.  Except for some narrowly-drawn exceptions, you usually have to get the explicit permission of the patient to share information in these areas with non-healthcare parties, including family members or spouses.

So in this particular situation, given that the competent patient explicitly denied permission to share her mental health information with her spouse and family members, I am ethically and legally required to follow her wishes.

Your spouse could be seeing a psychiatrist, and if the spouse tells the psychiatrist to not tell you anything about the care, the psychiatrist generally has to comply.  This situation especially comes up a lot with teenagers; and the parents get really exercised that the teenager controls the information flow while they are stuck paying the bill.

[230RN]

Very good, thank you.