Volume 193 - Issue 3
Suicide and mental disorder: the legal perspective
Author: Saxby Pridmore
Med J Aust 2010; 193 (3): 184-185. || doi: 10.5694/j.1326-5377.2010.tb03846.x
Published online: 2 August 2010
Published online: 2 August 2010
To the Editor: The medical view, which is repeatedly stated in the literature,1-3 is that up to 100% of those who complete suicide are suffering from a mental disorder. This leaves many doctors feeling they can be held responsible for all those who suicide, including those for whom there is no evidence of mental disorder. A recent High Court of Australia judgment, Stuart v Kirkland-Veenstra,4 illustrates that the medical and legal views of the relationship between suicide and mental disorder are different.
In this case, a wife alleged that police officers had failed to provide a duty of care towards her husband, who had been found by the officers in a car with a hose leading from the exhaust pipe into a rear window, but with the driver’s window down and the car engine cold. The officers talked to the husband, who claimed marital problems but that he had changed his mind about suicide and was planning to go home and discuss matters with his wife. The officers felt the husband was rational, cooperative and responsible, with no evidence of alcohol or drug misuse; they offered him assistance (which he declined) and allowed him to leave. Later that day, the husband completed the suicide. He had not told the officers that he was expecting to be served with papers relating to fraud charges that afternoon.
The Stuart v Kirkland-Veenstra judgment,4 in favour of the police officers, includes the following statements:
Suicide and attempted suicide are seen as reflective of psychological or psychiatric issues which may or may not involve ‘mental illness’ according to established diagnostic conventions . . .
Given the complexity and variety of factors which may lead to suicidal behavior, it would be a bold legislative step indeed to sweep it all under the rubric of mental illness, however widely defined.
Word limits prevent me from giving more detail about the case, but interested readers will find this accessible judgment valuable.
Clinicians dealing with “difficult” (but not mentally disordered) people in difficult circumstances often feel themselves to be in a perilous legal position, able to be held responsible for the actions of all those who choose to end their lives. The Stuart v Kirkland-Veenstra judgment clarifies the legal perspective, that suicide does not necessarily indicate the presence of a mental disorder, and that where mental disorder does not exist, human services personnel will not necessarily be held responsible for the actions of others.
References
- Robins E. The final months. A study of the lives of 134 persons who committed suicide. Oxford: Oxford University Press, 1981.
- Bertolote J, Fleischmann A, De Leo D, Wasserman D. Psychiatric diagnoses and suicide: revisiting the evidence. Crisis 2004; 25: 147-155. 0_pgfId-2059454
- Ernst C, Lalovic A, Lesage A, et al. Suicide and no axis I psychopathology. BMC Psychiatry 2004; 4: 7. 0_i1092204
- Stuart v Kirkland-Veenstra [2009] HCA 15. 0_i1092206