Risk Management With Suicidal Patients

In the introduction to this book, Bruce Bongar notes that the editors' goal is not to suggest what should be standards of care in the treatment of suicidal patients but rather "to challenge professionals to improve upon their own standards." I believe the book meets that goal nicely.

Risk Management With Suicidal Patients is a collection of papers by noted authors in the field. Three chapters and a portion of a fourth chapter have not been previously published. The book alternates between chapters focusing on risk management in the inpatient and outpatient care of the suicidal patient and chapters discussing pharmacological treatment of these patients. The juxtaposition of these two inherently different perspectives on the encounter between clinician and patient suggests the natural strain between forensic and clinical psychiatry and creates an experience similar to that of reading two novels simultaneously.

A few small shortcomings are easily noticed. Since the chapters overlap to a certain extent, some repetition occurs. For example, one is cautioned at least three times that antidepressants may energize a patient and increase suicidal risk. An error in one chapter—the statement that 1 percent of hospital inpatients commit suicide—is corrected in a postscript at the end of the book by the quoted author.

The volume's coverage of risk management is excellent; this is one of the best books on the subject that I have encountered. The detailed consideration of the many risky decisions inherent in clinical work with suicidal patients is first-rate. The pitfalls clinicians encounter are richly considered, demonstrating the depth of the authors' clinical experience. The two chapters on inpatient standards of care are particularly impressive and alone would justify the book's existence.

Any professional caregiver who works with suicidal patients will find interesting material in this book. Studied carefully, this small volume can deepen the clinician's knowledge in a measure equivalent to years of hard-won experience.

Dr. Davis is medical director at Central State Hospital in Petersburg, Virginia.