Strategies to Support Patients at Risk—Suicide, Self-Harm and Abuse

In Harm’s Way: Strategies to Support Patients at Risk—Suicide and Abuse

Things to Know that Might Help

If a patient discloses abuse, self-harm, or suicidal thoughts, be prepared to stop your assessment or treatment and address the comments. You need to maintain confidentiality of capable patients unless there is a significant risk of harm. In that case your duty to warn (keep others safe) may supercede your need to obtain consent.

As a physiotherapist, it’s important to notice the red flags, to offer information about resources and supports, and to refer to the appropriate professional.

Read More about Disclosure of Information:
Information and Privacy Commissioner of Ontario Fact Sheet

Remember:

  • Crisis lines are excellent resources for physiotherapists to call, as well as for guidance on how best to proceed if you are concerned about a patient.
  • Document the relevant information and actions taken in the clinical record, including only the critical details.
    For example: “Patient commenting that they are contemplating suicide, phoned crisis line together with the patient, patient agrees to follow up with family physician today.” Be prepared to redact these details if a third party asks for a copy of the clinical record and the notes do not relate to the insured injury.
  • Stay within your scope of practice as a health care professional by responding to concerning comments, asking a few probing questions, and then deciding on your course of action. Depending on the scenario, the course of action might be to offer resource information, or to contact a family member or physician, or even to call 911 in extreme cases.

About Patients

  • Don’t ignore concerning comments. Be human, be empathetic, and indicate your concern. For example: “That sounds very stressful, and I’m really concerned about you.” You may be the only health professional that the patient feels comfortable enough with to disclose this information to. How you respond might open doors for the patients to seek supportive services.
  • Ask your patient some probing questions to get more information about the degree of danger present. Consider asking if the patient has a suicide plan, or what motivates the cutting—is it a way to cope with stress, or is it an attempt at suicide? In an abusive scenario, you could ask if there are children witnessing the abuse, or whether there are guns in the home.
  • If you are in the middle of a hands-on technique when a patient makes a disclosure that causes you concern, be aware of how touch can be impactful and be careful of the effect on your patient if you suddenly take your hands off them after the disclosure.
  • Capable adults have the right to make their own choices, even if that means remaining in an abusive relationship. Offer your patient available resources for support services if they are open to it.
  • Involve your patient in your action plan whenever possible to foster trust. For example, say “I’m really concerned about your safety, I’m going to get the number for the suicide hotline and we’ll call them together for some advice.
  • Suggest to your patient that you’d like to create a team to support them. Explain that in addition to having a physiotherapist involved, you think it would be beneficial for them to connect with the school counsellor, physician, social worker, or psychologist to ensure that all of their needs are addressed by the right professional with the right skills.
  • Follow-up with patients who stop therapy mid-session, leave and cancel sessions. Physiotherapy has great restorative value for people who may not feel valued themselves and might need an open door reminder.

About Patients Up to 18 Years Old

In 2018, the age of protection was raised to include youth up to 18 years old. Youth who are 16 and 17 years old are now eligible to receive protection services from Children’s Aid Societies. While reporting for 16 and 17-year old youth is not mandatory, please contact your local Children’s Aid Society if you have concerns about a youth.

Thanks to everyone who joined our webinar on strategies to support patients with mental health challenges. We apologize for the technical difficulties with the audio. Check out the archived webinar here: https://youtu.be/9ppMS42Rlfs (fast forward to 13:45 to skip the audio issues).

If you have additional questions please call our Practice Advice team at 1-800-583-5885 ext. 241.

Questions for the Practice Advisor?

practiceadvice@collegept.org
647-484-8800
1-800-583-5885

Finding Help in a Crisis: Contact CAMH

CAMH Crisis Resources

Mandatory Reporting

Find Out What Your Mandatory Reporting Obligations Are

This isn’t Easy—We are Here if You Need Us

If these types of conversations make you uncomfortable, know that you are not alone. It’s important to discuss this with colleagues and to become more comfortable speaking about these topics so that if/when such a situation arises you can react professionally and appropriately with your patient and not miss an opportunity to build trust and to provide critical support when it is needed.

For more information on this topic or to talk through your individual situation, please feel free to reach out to a Practice Advisor at 647-484-8800 or 1-800-583-5885 or advice@collegept.org.


The College of Physiotherapists of Ontario would like to acknowledge the work of the College of Physical Therapists of British Columbia as a source for some of the material on this page.


When a Patient is Suicidal—Privacy Considerations & Your Obligations

There is an expectation that all health care providers, including physiotherapists, understand the importance of protecting a patient's privacy. This includes getting patient consent for collection, use and disclosure of all personal health information.

Ontario's privacy laws are in place to allow patients to have control over who has access to his or her personal health information. However, they are not meant to prevent health care providers from immediately disclosing personal health information in specific and limited circumstances.

One such circumstance is when an physiotherapist has a patient who has expressed suicidal thoughts.

If the PT has reasonable grounds to believe that the patient may seriously harm him or herself, or possibly others, the Personal Health Information Protection Act (PHIPA) permits this disclosure without getting the patient's consent.

The physiotherapist is expected to use his or her professional judgment when assessing the situation to determine if there are reasonable grounds to believe that serious harm will occur and if it is appropriate to disclose this information.

The courts have set out circumstances in which concern for public safety may warrant the disclosure of information gotten by a health care provider to reduce or eliminate risk of harm. The factors for consideration are as follows:
  • there is a clear risk to an identifiable person or a group of persons
  • there is a risk of serious bodily harm or death and
  • the danger is imminent
There are no restrictions on the types of persons this information can be disclosed to—the PT should use his or her best judgment to determine who would be the most appropriate person to contact.

Depending on the situation, a family member or the patient's family doctor or mental health care provider would be appropriate. In some urgent cases, it may be more appropriate to call 911 for emergency services.

If the physiotherapist is uncertain as to whether disclosure should be made, he or she should contact a lawyer or the Information and Privacy Commissioner.

Important: all disclosures should be documented in the patient chart.