Dealing with suicidal clients?

April 26, 2011 2:15 PM

In my law practice, I regularly encounter clients who are despondent and suicidal. I don't feel that I am well prepared for dealing with this issue. Without considering the ethical issues as to disclosure, what is the best course of action when dealing with a client who tells you that they're considering suicide? What resources are available as a guide to dealing with a suicidal client?

A mentally ill client recently called me to tell me that she is considering suicide. This happens often and I'm never sure how to talk to clients who are threatening suicide.

I understand that attorney/client privilege may prevent me from disclosing the conversation. As a result, I am sometimes the only person who has the opportunity to change my client's mindset. But I'm never certain that I'm saying the right things or doing my best to address the crisis.

I'm interested in guides to crisis intervention, but many of these are directed toward medical providers who have different ethical and professional considerations. Are there any guides to handling this from a legal perspective that focus on the actual crisis without getting bogged down in ethical issues? What about non-legal guides for professionals in other fields?

posted by Dignan to law & government (11 answers total)

I know my professional code of ethics, which includes confidentiality, has an exception for FUTURE acts of harming self or others. I find it hard to believe that lawyer/client confidentiality does not have this same exception.
posted by hworth at 2:20 PM on April 26, 2011

Generally within mental health you have confidentiality in many areas, to the extent allowed by law. The point of potential harm to yourself or others is where the law comes down on the side of breaking it.

On preview, agreeing with hworth. It can even go beyond the ability to warn to a duty to warn, from Tarasoff v Board of Regents -- that phrase might be one to explore in terms of what it means for attorneys. A quick resource would be the national suicide hotline -- 1800-273-TALK.
posted by bizzyb at 2:25 PM on April 26, 2011

If you're interested, you could call your local suicide prevention hotline and ask them for advice about how they could be a resource in this kind of matter - you might even want to take their training, just to give you some tools for dealing with clients who feel this way.

I don't know specifics about the attorney/client privilege, but in my field of psychology, we are allowed to break confidentiality in certain instances, including danger to self or others.

This online CLE course (Attorney Client Privilege and the Suicidal Client) looks like it covers exactly the issue you're raising.
posted by jasper411 at 2:27 PM on April 26, 2011

If your law firm doesn't have someone who can advise you, try calling your ARDC or your board of bar examiners.
posted by crush-onastick at 2:28 PM on April 26, 2011 [1 favorite]

I am a lawyer. I would call the state bar or the state ethics hotline and see if there's anything they can point you to. I would also reach out to colleagues in your firm and outside and see if anybody else has encountered this problem and how they've handled it. I'm sure other attorneys in your area of practice must see the same thing.
posted by bananafish at 2:28 PM on April 26, 2011 [1 favorite]

Ditto on calling a hotline. The national suicide prevention hotline # is 1-800-273-8255. They can help guide your response. It's confidential and you don't have to reveal any information that will identify you or your client. Better still, pass the number on to your clients - it is easier for hotline workers to intervene with the person in crisis than through a second party

Also, if you encounter suicidal clients on a regular basis I strongly recommend participating in or having your workplace sponsor an Applied Suicide Intervention Skills workshop (ASIST). A little Googeling should point you towards trainers in your area. The ASIST model It's almost universally used as part of suicide hotline volunteer training. Police departments, school districts, emergency response personnel and agencies who work with volatile, vulnerable and at risk populations use it as well. The training is not necessarily geared towards one type of profession or another, it's a model for how to have a conversation about suicide and how to intervene effectively with the suicidal person.

As far as I know there is very little within it that would require you to divulge privileged information to third parties. That said, notifying police or 911 when someone is in imminent danger to themselves falls within the ethical scope of most professionals trained in this model. By all means check with your bar association about exceptions to client/attorney privilege.

By the by. I am not at all affiliated with any ASIST training organization in any capacity but have been trained in and use the model in my work.

Memail me if you'd like more concrete suggestions for how to respond.
posted by space_cookie at 3:02 PM on April 26, 2011

My state bar has an ethics hotline that occasionally suggest authority to review or direct you to bar resources to help with some issues. I would encourage you also to discuss the matter with a colleague or two through your local bar association.

Aside from the ethical concerns, even if disclosure is permitted, Tarasoff does not apply to attorneys. Some states have especially strong policy statements protecting client confidence. (See, e.g., Cal. Bus. & Prof. Code section 6068(e) and Cal. Evid. Code section 956.5.) The real question is a practical one: even if disclosures are permitted, would my doing so undermine the relationship of trust a client must necessarily enjoy with an attorney? The disclosures you make may not be effective at obtaining the help your client needs, but they will pretty effectively tell the client that the client can't trust you. As soon as that happens, you will have little or no ability to effectively counsel your client, and very little moral authority to persuade the client to accept your advice.
posted by Hylas at 3:03 PM on April 26, 2011 [1 favorite]

My office had a one-hour QPR training, which basically teaches you to ask the person whether they're suicidal and then refer the person to a crisis center or hotline. I don't know much about it or whether the method has been found to work, but the couple of times I've had to use it I've found it helpful.
posted by craichead at 3:09 PM on April 26, 2011

Suicide is a crime in some states, so in theory the crime-fraud exception might apply in a worst case scenario. But that said, I think you should get the support of the local bar association and other lawyers in your area of practice. Fwiw, in my old practice we would tell people to get therapy if they started to lean on us as therapists.
posted by yarly at 3:47 PM on April 26, 2011

You really need to check your state ethics rules. For example, my state contains the following provision:

Rule 1.14. Client with Diminished Capacity

(a) When a client's capacity to make adequately considered decisions in connection with a representation is diminished, whether because of minority, mental impairment or for some other reason, the lawyer shall, as far as reasonably possible, maintain a normal client-lawyer relationship with the client.

(b) When the lawyer reasonably believes that the client has diminished capacity, is at risk of substantial physical, financial or other harm unless action is taken and cannot adequately act in the client's own interest, the lawyer may take reasonably necessary protective action, including consulting with individuals or entities that have the ability to take action to protect the client and, in appropriate cases, seeking the appointment of a guardian ad litem, conservator or guardian.

(c) Information relating to the representation of a client with diminished capacity is protected by Rule 1.6. When taking protective action pursuant to paragraph (b), the lawyer is impliedly authorized under Rule 1.6(a) to reveal information about the client, but only to the extent reasonably necessary to protect the client's interests.

(d) This Rule is not violated if the lawyer acts in good faith to comply with the Rule.

Someone seriously considering suicide, i.e. someone who poses a risk to themselves, may arguably be categorized as having diminished capacity, which would trigger the above rule, particularly subsection (b). But you'll need to check with your own state bar to see how that works.
posted by valkyryn at 4:37 PM on April 26, 2011

I'm never sure how to talk to clients who are threatening suicide.

I can't speak to the legal ethics issues at all, but I can tell you that basic training in something called "active listening" is an amazingly powerful tool for talking with folks who are thinking about suicide. I got training when I volunteered years ago for a 24-hour crisis hotline and it helped me enormously in staying calm and reflecting back what I was hearing in ways that helped the suicidal person in crisis feel heard and respected, which in itself can go a long way toward lowering the intensity of the crisis. It's a skill that has repaid the training in countless important ways (when I remember to use it, I should admit), and you might want to nose around your local mental health or dispute settlement centers for trainings nearby. Mine was free, fwiw.
posted by mediareport at 7:09 PM on April 26, 2011