by Andrew E. Slaby

About the author: Andrew E. Slaby is a clinical professor of psychiatry at New York University and New York Medical College.

Evaluating and managing suicidal outpatients has long made clinicians fearful. Now, as managed and capitated care continues limiting hospitalizations and outpatient treatments, clinicians have become even more anxious about treating patients who are suicidal. Fortunately, a few basic principles of patient management greatly facilitate treating self-destructive outpatients and preventing their suicides.

It is not always possible to prevent suicide, but in most instances the impulse can be significantly reduced when clinicians, patients and patients' families understand the factors that impact suicide risk. Hopelessness, more than depression, predicts suicide. Patients who suicide do not want to die; they simply want to end their pain. When they can see another way to end the pain, they use...