A Date With Death: Management of Time-Based and Contingent Suicidal Intent

Objective:The patient who voices suicidal intent in terms of the future or in terms of certain life contingencies presents special difficulties for the therapist. The authors outline the challenges posed by this problem for assessment, clinical management, and risk management. Method:The authors examined and analyzed case examples from both clinical and risk-management aspects. Results:Problematic cases can be grouped into categories that offer insight as to management. The authors discuss this area and offer suggestions for appropriate clinical responses to this challenge. Conclusions:The authors recommend that therapists 1) treat the expressed “date with death” as a communication to be explored, 2) explore the problem of helplessness while monitoring their own countertransference responses, 3) assess the patient’s competence to inform clinicians about suicidal state, and 4) readily use involuntary commitment. Am J Psychiatry 1998; 155: 1502-1507