Grounding Thick Normative Facts

Many philosophers have been concerned with the nature of thick normative concepts. In this paper, I try to motivate a different project: understanding the nature of thick normative properties and facts. I propose a ground‐theoretic approach to this project. I then argue that some of the simplest and most initially plausible ways of understanding thick facts fail and that we are forced to accept some initially implausible views. I try to show how these views are not so implausible after all.     

The Prevention of Suicidal Behaviors: An Overview

The authors discuss the development of the concept of prevention as it has evolved from the public health and mental health fields. Concepts of epidemiology, treatment, and community mental health are defined in terms of their contributions to the evolution of prevention thinking. Four models of prevention are presented and critiqued: the public health model, the operational model, the antecedent conditions model, and the injury control model. Essential ingredients for implementing effective preventive interventions are presented, as well as examples of practical preventive interventions.     

Inpatient Standards of Care and the Suicidal Patient. Part I: General Clinical Formulations and Legal Considerations

The most common legal action involving psychiatric care is the failure to reasonably protect patients from harming themselves. In this regard it is critical to understand that courts have tended to impose much stricter standards on inpatient than on outpatient care; that at the present time, most malpractice actions involve clinical activities related to inpatient care (negligent admission, treatment, supervision, discharge, etc.). This article reviews the current climate in the legal and clinical formulation of standards of care for hospitalized adult suicidal patients. It suggests general guidelines for effective assessment, management, and treatment procedures that balance the need for high-quality care by a reasonable and prudent practitioner with the requirements of court-determined and statutory standards. The authors specifically discuss court cases that show common failure situations in inpatient care, discharge planning, and follow-up (e.g., problems in pharmacotherapy, the decision to hospitalize, the assessment of imminence and lethality, etc.). The paper also emphasizes the crucial element of clinical judgment in developing any inpatient standard of care.