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Diagnosis, management and discharge of suicidal man (04HDC00671)
Download Diagnosis, management and discharge of suicidal man (04HDC00671) (PDF 39Kb)
(04HDC00671, 30 March 2006)
Psychiatrist ~ Psychiatric nurse ~ Enrolled nurse ~ Hospital
systems ~ Standard of care ~ Consultation with family ~ Social
crisis ~ Home leave ~ Suicide ~ Right 4(2)
A man with a history of depressive
disorder was admitted to hospital after attempting suicide. The
man's family was not satisfied with an initial proposal to
discharge him, as they considered he had a mental illness. The
patient was admitted to the hospital psychiatric unit as a
voluntary patient. An enrolled nurse appointed as the patient's key
worker undertook an initial assessment and determined that the
patient was at medium risk.
The following morning the patient
was assessed by a psychiatrist, who concluded that the patient was
not suffering from a mental illness. A referral to relationship and
alcohol services for counselling was planned. The psychiatrist
reviewed the patient the next morning, and planned to discharge
him. The patient became anxious as the day progressed, and
indicated to staff that he was not happy about being discharged.
Members of his family also expressed concern to ward staff about
his condition. As a result of these concerns, following a
multidisciplinary team meeting, the decision was made to grant the
patient leave from the ward, rather than discharge. A discharge
meeting was to be held the following week.
The patient was released and
committed suicide the following day. His family complained that he
was not diagnosed with depression, and that home leave was granted
despite clear concerns about the risk of self-harm.
It was held that the psychiatrist
provided the patient with an apparently appropriate diagnosis but
undertook inadequate consultation with the patient's family, who
should have been specifically consulted about the decision to grant
home leave. The psychiatrist was held to have breached Right
The hospital was also held to be in
breach of Right 4(2) for allowing an enrolled nurse to be appointed
as the patient's key worker, as this was outside the scope of
practice of an enrolled nurse. This practice has now been stopped.
It was also recommended that the hospital review its systems of
care, particularly in relation to consultation.
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