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J Psychiatr Pract. 2019 Nov;25(6):470-474. doi: 10.1097/PRA.0000000000000434.

Welfare Checks and Therapeutic Risk Management.

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1
WORTZEL: Michael K. Cooper Professor of Neurocognitive Disease; Director of Neuropsychiatry; Associate Professor in Psychiatry, Neurology, and Physical Medicine & Rehabilitation; and Faculty for the Forensic Psychiatry Fellowship at the University of Colorado School of Medicine, Aurora, CO. He is also Director of Neuropsychiatric Services for the Rocky Mountain MIRECC at the Rocky Mountain Regional VA Medical Center, Aurora, CO BARNES, CANNIZZARO: Clinical and Research Psychologists with the Rocky Mountain MIRECC. Dr Barnes is an Assistant Professor in the Department of Psychiatry at the University of Colorado School of Medicine, Aurora, CO VILLARREAL: Suicide Prevention Manager for the VA Eastern Colorado Health Care System, Aurora, CO MATARAZZO: Director of Clinical Services for the Rocky Mountain MIRECC and Associate Professor in the Department of Psychiatry at the University of Colorado School of Medicine, Aurora, CO ALLEN: Medical Director for Psychiatric Emergencies and Telehealth at UCHealth, Medical Director of Rocky Mountain Crisis Partners and Professor of Psychiatry and Emergency Medicine at the University of Colorado School of Medicine, Aurora, CO.

Abstract

In clinical practice, welfare checks have become a fairly common aspect of suicide prevention. At the same time, the medical literature provides almost no guidance to inform clinicians under what circumstances welfare checks should be requested, how best to go about placing those requests, or how to document decision-making related to this important subject. Literature searches spanning both PubMed and Google Scholar failed to yield any applicable results. Performed correctly, welfare checks have the potential to be life-saving interventions for persons in suicidal crises. Performed incorrectly, welfare checks may become an overly defensive practice that damages therapeutic relationships, violates patients' rights, and consumes important and limited community resources. The need for thoughtful guidance to assist clinicians in navigating these difficult clinical scenarios is long overdue. This column, the second in a 2-part series, offers an approach to welfare checks informed by the tenets of therapeutic risk management.

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