Clinicians Digest Sept/Oct 2008 - Page 6

"Please Call 911"

Remember the days before voicemail, when therapists' answering machines left a colleague's number for clients to call during emergencies, vacations, or prolonged absences? Today, therapists' voicemail instructions typically advise clients to call 911 or go to the nearest hospital emergency room. Unfortunately, argues psychiatrist Robert Simon, director of the program in psychiatry and law at Georgetown University, that message falls short of meeting therapists' ethical and legal requirements, especially with clients who are extremely vulnerable or have a high risk of suicide.

In the February 1 Psychiatric Times, Simon points out that desperate and suicidal clients may have crippling reservations about calling 911 and bringing sirens, flashers, police, and paramedics to their door. Visiting a hospital emergency room (ER) often entails long waits and confusing, impersonal procedures, and many ERs aren't adequately staffed to deal with psychiatric issues. It may be asking far too much of suicidal people to even get themselves to the nearest hospital.

What desperate clients need when they call their therapists, says Simon, is specific instructions for how to get reassuring human contact: a colleague's phone number or, at minimum, the number of a good suicide hotline.

Managed care policies have become an everyday part of therapists' treatment protocol, and some companies ask therapists to include the 911 and ER messages on their voicemail, which may be why they've became so prevalent. But Frederick Reamer, who helped write the National Association of Social Workers Code of Ethics, warns that therapists aren't legally covered just because they follow what managed care companies want them to do.

Ethical therapists, says Simon, are obliged to render competent care. A message telling patients to call an emergency department, he says, is neither adequate coverage nor competent care, and may even feel like abandonment.

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