Psychologists' beliefs concerning confidentiality with suicide, homicide, and child abuse

The Development and Utilisation of a Suicide Risk Assessment Interview Schedule

Suicide is increasingly widespread in South Africa and is considered to constitute a serious public health problem. It is not only the most common emergency encountered by mental health care professionals but also has the distinction of being one of the few potentially fatal psychological conditions. The accurate determination of suicide risk in clinical practice is difficult. Despite vast amounts of research, no one assessment tool or method, when applied to individual clients, has been demonstrated to be ultimately superior in helping clinicians to accurately estimate risk. A clinician's failure to adequately assess suicide risk may result in morbidity or mortality, and has the added complication of leaving the clinician to face negative emotional, personal, professional, and legal consequences. This article illustrates how research findings and empirical studies have been utilised to formulate a Suicide Risk Assessment Interview Schedule (SRAIS) designed to assist the clinician to make a thorough assessment of suicide risk by avoiding errors of omission. Two case vignettes are included to illustrate how the SRAIS has been used to guide the process of risk assessment and management.

Consent and confidentiality in clinical work with young people

Consent and confidentiality are increasingly important in clinical practice. However, the dilemmas faced by mental health practitioners can be highly complex and difficult to resolve. This difficulty is compounded by the fact that consent and confidentiality are subject to several different types of legislation based on different principles, and many of the policies which are formulated for general medical practice may not fit well with the mental healthcare context. The ethical principles, evidence base, legal context, developmental considerations and clinical context relevant to each situation must all be integrated, in consultation with children and adolescents and their parents, in order to arrive at a treatment plan which is sensitive to the views of all, developmentally appropriate for the children and adolescents, and responsive to changes in the situation or attitudes. We offer some practical approaches, including clinical practice algorithms, to consider the issues of consent and confidentiality in the child and adolescent mental healthcare setting.