When a FO identifies a threat of suicidal or homicidal behavior during a face-to-face interview, this situation does not result in an automatic deferral of the CDR. The FO must consider handling this situation under the deferral provisions in DI 13005.020. In these situations, contact the regional office (RO) providing all pertinent details of the suicidal or homicidal behavior in the case, and request assistance in determining if the case applies for a deferral.

When the FO decides to use the optional CDR procedure, every RO develops a plan for the FO or a DDS physician to contact the medical source of the individual with the potential suicidal or homicidal behavior.

This procedure provides instructions for the FO when the case folder contains the name of the last known medical source. It is not mandatory to follow this procedure. The FO will receive a flag from the PC when a CDR indicates that the individual might potentially display suicidal or homicidal behavior. Experience has shown that medical source can sometimes furnish information on how the individual may react to a CDR.

Under the optional CDR procedure, the FO will ask the medical source for an opinion concerning any negative effects that the CDR may have on the disabled individual. Before initiating personal contact, the FO must contact the source. If the FO decides to follow this procedure for the case, it must comply with regional policy before contacting the medical source or referring the case to the DDS.

When the DDS contacts the individual's source and determines the CDR should continue, the DDS will return the folder to the FO. The FO will complete a personal interview and then return the case to the DDS to complete the medical review. If the DDS determines a CDR would have a negative effect on an individual's mental health or increase potential suicidal or homicidal behavior, the DDS must contact the RO for guidance.

The FO's must follow clear and concise instructions when contacting the medical source, see GN 03305.020. The letter to the physician should be similar to the example below, and the FO must release the letter with a confidential cover sheet, for example the form SSA-1994 (Cover Sheet Confident Medical Info).

Example:

“Our records show that you were the medical source for (HA's Name) in (date). (HA's Name) case is now scheduled for a continuing disability review. Because of the individual's past medical history and since you continue to treat the person we need your assessment as to what impact the initial interview and subsequent contacts by SSA or State agency employees might have on (HA's Name) mental status or suicidal or homicidal potential. Please respond as soon as possible.”

The FO should check the second block on form SSA-1994 and follow-up with the medical source if there is no response within 10 days. During any telephone contact with the medical source, the FO must emphasize that the basis of the inquiry is SSA's concern for the individual's health and well-being.

If the source states that they cannot make this judgment, proceed with the CDR in the usual manner. If the source says they is no longer treating the disabled individual, the FO should make one attempt to contact a family member or community representative from the case folder who has close contact with the individual. The FO must also attempt to identify the individual's current medical source, and if identification occurs, write to this source. Otherwise, do not make any further attempts and schedule the personal contact.

If the medical source indicates that the personal contact would have negative effects on the individual's mental health or increase potential threat of suicidal or homicidal behavior, the FO should document the case folder and contact the RO for guidance. The FO should consider deferring the CDR in life-threatening situations.

Schedule the personal contact and process the case as usual under the following circumstances:

1. 1. 

   If the medical source states that there is no current threat of suicide or homicide behavior potential; or

2. 2. 

   The refusal of the medical source to provide an opinion on the individual's suicide or homicide behavior potential; or

3. 3. 

   The medical source states that the individual is no longer a patient and is not aware of a current treating source.

In all circumstances before routing the folder to the DDS, the FO must assure full and accurate documentation of the case folder.

It is essential for the FO to keep two major facts in mind when handling cases involving potential suicidal or homicidal behavior. First, the FO must constantly remain alert to the possibility of such behavior and maintain close telephone contact with the DDS, not only for the purpose of initial notification of this type of case, but to keep the DDS advised of any subsequent development and assist when necessary.

Second, the FO must be patient, sensitive, and considerate when dealing with a potentially suicidal or homicidal individual. The FO must thoroughly explain the appeal steps to the disabled individual and explain the benefit continuation provisions in P.L. 98-460.