Working With Suicidal Patients1. Working with
Suicidal Patients
Suicide
Risk
Assessment
M a p l e C o u n s e l i n g
C e n t e r
M a r k A l l i s o n
www.thebeverlyhillstherapist.com 1
2. What we will cover in this
workshop
History
of
the
suicide
crisis
intervention
lines
What
the
bleep
do
you
know
about
suicide?
Suicide
Facts
Vs.
Myths
Legal
vs.
Ethical
practice
Risk
Assessment:
Assessing
for
Lethality
Interventions
Role
Play
www.thebeverlyhillstherapist.com 2 ©Mark Allison 2010
3. History of Suicide
Prevention Hotlines
The
Los
Angeles
Suicide
Prevention
Center
(SPC)
founded
in
1958,was
the
first
agency
of
its
kind
to
establish
a
crisis
line
offering
round
the
clock
telephone
counseling
to
people
in
suicidal
crisis.
SPC's
telephone
intervention
model
has
been
adopted
by
most
crisis
centers
and
hotlines
across
the
nation
and
throughout
the
world.
www.thebeverlyhillstherapist.com 3 ©Mark Allison 2010
5. what the bleep do you know
about suicide!
1. More women than men attempt suicide?
www.thebeverlyhillstherapist.com 4 ©Mark Allison 2010
6. what the bleep do you know
about suicide!
1. More women than men attempt suicide?
Women attempt suicide three times as often as men, though men
Die by suicide four times as often as women.
www.thebeverlyhillstherapist.com 4 ©Mark Allison 2010
7. what the bleep do you know
about suicide!
1. More women than men attempt suicide?
Women attempt suicide three times as often as men, though men
Die by suicide four times as often as women.
2. More people die by suicide than by homicide?
www.thebeverlyhillstherapist.com 4 ©Mark Allison 2010
8. what the bleep do you know
about suicide!
1. More women than men attempt suicide?
Women attempt suicide three times as often as men, though men
Die by suicide four times as often as women.
2. More people die by suicide than by homicide?
30,000 die by suicide, 20,000 by homicide
www.thebeverlyhillstherapist.com 4 ©Mark Allison 2010
9. what the bleep do you know
about suicide!
1. More women than men attempt suicide?
Women attempt suicide three times as often as men, though men
Die by suicide four times as often as women.
2. More people die by suicide than by homicide?
30,000 die by suicide, 20,000 by homicide
3. Most suicides are committed by drug overdose?
www.thebeverlyhillstherapist.com 4 ©Mark Allison 2010
10. what the bleep do you know
about suicide!
1. More women than men attempt suicide?
Women attempt suicide three times as often as men, though men
Die by suicide four times as often as women.
2. More people die by suicide than by homicide?
30,000 die by suicide, 20,000 by homicide
3. Most suicides are committed by drug overdose?
Actually, most suicides are by gun shot.
www.thebeverlyhillstherapist.com 4 ©Mark Allison 2010
11. what the bleep do you know
about suicide!
1. More women than men attempt suicide?
Women attempt suicide three times as often as men, though men
Die by suicide four times as often as women.
2. More people die by suicide than by homicide?
30,000 die by suicide, 20,000 by homicide
3. Most suicides are committed by drug overdose?
Actually, most suicides are by gun shot.
4. In the US, Suicides occur most frequently in the Spring?
www.thebeverlyhillstherapist.com 4 ©Mark Allison 2010
12. what the bleep do you know
about suicide!
1. More women than men attempt suicide?
Women attempt suicide three times as often as men, though men
Die by suicide four times as often as women.
2. More people die by suicide than by homicide?
30,000 die by suicide, 20,000 by homicide
3. Most suicides are committed by drug overdose?
Actually, most suicides are by gun shot.
4. In the US, Suicides occur most frequently in the Spring?
True, People die by suicide more often during spring and summer. The
idea that suicide is more common in the winter holidays is a
misconception.
www.thebeverlyhillstherapist.com 4 ©Mark Allison 2010
13. what the bleep do you know
about suicide!
1. More women than men attempt suicide?
Women attempt suicide three times as often as men, though men
Die by suicide four times as often as women.
2. More people die by suicide than by homicide?
30,000 die by suicide, 20,000 by homicide
3. Most suicides are committed by drug overdose?
Actually, most suicides are by gun shot.
4. In the US, Suicides occur most frequently in the Spring?
True, People die by suicide more often during spring and summer. The
idea that suicide is more common in the winter holidays is a
misconception.
5. It’s best not to talk about suicide to a depressed client?
www.thebeverlyhillstherapist.com 4 ©Mark Allison 2010
14. what the bleep do you know
about suicide!
1. More women than men attempt suicide?
Women attempt suicide three times as often as men, though men
Die by suicide four times as often as women.
2. More people die by suicide than by homicide?
30,000 die by suicide, 20,000 by homicide
3. Most suicides are committed by drug overdose?
Actually, most suicides are by gun shot.
4. In the US, Suicides occur most frequently in the Spring?
True, People die by suicide more often during spring and summer. The
idea that suicide is more common in the winter holidays is a
misconception.
5. It’s best not to talk about suicide to a depressed client?
Many depressed people have already considered suicide as an option
Discussing it openly helps the suicidal person sort through the problems
And generally provides a sense of relief and understanding.
www.thebeverlyhillstherapist.commost helpful things you can do.
It’s one of the 4 ©Mark Allison 2010
16. what the bleep do you know
about suicide!
6. In California, if a client tells a therapist that he is going to kill himself,
the therapist, by law, must report it?
www.thebeverlyhillstherapist.com 5 ©Mark Allison 2010
17. what the bleep do you know
about suicide!
6. In California, if a client tells a therapist that he is going to kill himself,
the therapist, by law, must report it?
Kinda of False. In California, the law does not require a licensed
therapist to report a suicide threat by their patient.
Two conditions where it is mandatory:
1. A minor or student at a school
2. If Client threatens to take his own life along with another person
and the indented victim is reasonably identifiable.
www.thebeverlyhillstherapist.com 5 ©Mark Allison 2010
18. what the bleep do you know
about suicide!
6. In California, if a client tells a therapist that he is going to kill himself,
the therapist, by law, must report it?
Kinda of False. In California, the law does not require a licensed
therapist to report a suicide threat by their patient.
Two conditions where it is mandatory:
1. A minor or student at a school
2. If Client threatens to take his own life along with another person
and the indented victim is reasonably identifiable.
7. Suicide rates are generally higher than the national average in the
Western states and lower in the Eastern and Midwestern states?
www.thebeverlyhillstherapist.com 5 ©Mark Allison 2010
19. what the bleep do you know
about suicide!
6. In California, if a client tells a therapist that he is going to kill himself,
the therapist, by law, must report it?
Kinda of False. In California, the law does not require a licensed
therapist to report a suicide threat by their patient.
Two conditions where it is mandatory:
1. A minor or student at a school
2. If Client threatens to take his own life along with another person
and the indented victim is reasonably identifiable.
7. Suicide rates are generally higher than the national average in the
Western states and lower in the Eastern and Midwestern states?
True, According to NAMI, it is highest in the western states...
www.thebeverlyhillstherapist.com 5 ©Mark Allison 2010
20. what the bleep do you know
about suicide!
6. In California, if a client tells a therapist that he is going to kill himself,
the therapist, by law, must report it?
Kinda of False. In California, the law does not require a licensed
therapist to report a suicide threat by their patient.
Two conditions where it is mandatory:
1. A minor or student at a school
2. If Client threatens to take his own life along with another person
and the indented victim is reasonably identifiable.
7. Suicide rates are generally higher than the national average in the
Western states and lower in the Eastern and Midwestern states?
True, According to NAMI, it is highest in the western states...
8. Young people who are suicidal often give warning signs
www.thebeverlyhillstherapist.com 5 ©Mark Allison 2010
21. what the bleep do you know
about suicide!
6. In California, if a client tells a therapist that he is going to kill himself,
the therapist, by law, must report it?
Kinda of False. In California, the law does not require a licensed
therapist to report a suicide threat by their patient.
Two conditions where it is mandatory:
1. A minor or student at a school
2. If Client threatens to take his own life along with another person
and the indented victim is reasonably identifiable.
7. Suicide rates are generally higher than the national average in the
Western states and lower in the Eastern and Midwestern states?
True, According to NAMI, it is highest in the western states...
8. Young people who are suicidal often give warning signs
True.
www.thebeverlyhillstherapist.com 5 ©Mark Allison 2010
23. what the bleep do you know
about suicide!
9. Most deaths by suicide can be prevented
www.thebeverlyhillstherapist.com 6 ©Mark Allison 2010
24. what the bleep do you know
about suicide!
9. Most deaths by suicide can be prevented
True. Well...kind of....
www.thebeverlyhillstherapist.com 6 ©Mark Allison 2010
25. what the bleep do you know
about suicide!
9. Most deaths by suicide can be prevented
True. Well...kind of....
10. The most important predictor of suicide attempt is the presence
of a specific detailed plan, no matter what age or sex the
person is.
www.thebeverlyhillstherapist.com 6 ©Mark Allison 2010
26. what the bleep do you know
about suicide!
9. Most deaths by suicide can be prevented
True. Well...kind of....
10. The most important predictor of suicide attempt is the presence
of a specific detailed plan, no matter what age or sex the
person is.
True, a detailed specific plan should alarm a therapist that
patient is at a higher lethality risk.
www.thebeverlyhillstherapist.com 6 ©Mark Allison 2010
27. facts and myths about Suicide
Some
Statistics
•
Suicide
took
the
lives
of
32,637
people
in
2005
(CDC
2008)
•
Suicide
is
the
11th
ranking
cause
of
death
in
the
US
3rd
for
young.
(McIntosh,
2005).
•
816,000
annual
attempts
in
US.
Translates
to
one
attempt
every
39
seconds
(CDC
2004).
•
In
2001,
55%
of
suicides
were
committed
with
a
firearm
(Anderson
and
Smith
2003).
Groups
at
Risk
•
3
Female
attempts
to
every
male
attempt.
•
Males
are
four
times
more
likely
to
die
from
suicide
than
females
(CDC
2004).
•
Suicide
is
the
eighth
leading
cause
of
death
for
all
U.S.
men
(Anderson
and
Smith
2003).
www.thebeverlyhillstherapist.com 7 ©Mark Allison 2010
28. facts and myths about Suicide
Myth
Suicidal
people
just
want
to
die.
Fact
Most
of
the
time,
suicidal
people
are
torn
between
wanting
to
die
and
wanting
to
live.
Most
suicidal
individuals
don't
want
death;
they
just
want
to
stop
the
great
psychological
or
emotional
pain
they
are
experiencing.
Myth
People
who
commit
suicide
do
not
warn
others.
Fact
Eight
out
of
every
10
people
who
kill
themselves
give
definite
clues
to
their
intentions.
They
leave
numerous
clues
and
warnings
to
others,
although
clues
may
be
non‐verbal
or
difficult
to
detect.
Myth
People
who
talk
about
suicide
are
only
trying
to
get
attention.
They
won't
really
do
it.
www.thebeverlyhillstherapist.com 8 ©Mark Allison 2010
29. facts and myths about Suicide
Fact
Few
commit
suicide
without
first
letting
someone
know
how
they
feel.
Those
who
are
considering
suicide
give
clues
and
warnings
as
a
cry
for
help.
Over
70%
who
do
threaten
to
commit
suicide
either
make
an
attempt
or
complete
the
act.
Myth
Don't
mention
suicide
to
someone
who's
showing
signs
of
depression.
It
will
plant
the
idea
in
their
minds
and
they
will
act
on
it.
Fact
Many
depressed
people
have
already
considered
suicide
as
an
option.
Discussing
it
openly
helps
the
suicidal
person
sort
through
the
problems
and
generally
provides
a
sense
of
relief
and
understanding.
It
is
one
of
the
most
helpful
things
you
can
do.
www.thebeverlyhillstherapist.com 9 ©Mark Allison 2010
30. Legal & Ethical Issues
In
California,
the
law
does
not
require
a
licensed
therapist
to
report
a
suicide
threat
by
their
patient.
However
Evidence
Code
1024
protects
the
therapist
if
they
report
it.
We
do
however
have
a
legal
and
ethical
duty
to
take
“reasonable
steps”
to
ensure
the
safety
of
suicidal
clients”
Two
conditions
where
the
law
would
require
to
report:
1.
A
minor,
a
student
at
school.
2.
If
client
threatens
to
take
his
own
life
and
the
life
of
another
person
and
the
intended
victim
is
reasonably
identifiable.
www.thebeverlyhillstherapist.com 10 ©Mark Allison 2010
31. Legal & Ethical Issues
If
therapist
does
decide
to
break
confidentiality
to
report
a
suicide
threat
or
ideation.
Evidence
Code
1024
protects
the
therapist.
Evidence
Code
1024:
if
psychotherapist
has
reasonable
cause
to
believe
that
patient
is
in
such
mental
or
emotional
condition
as
to
be
dangerous
to
him/herself
or
to
the
person
or
property
of
another
and
that
disclosures
of
communication
is
necessary
to
prevent
the
threatened
danger
Therapist
can
contact
authorities
who
will
initiate
a:
5150:
72
hour
involuntary
hold.
5250
14
day
hold
5260
14
additional
days
www.thebeverlyhillstherapist.com 11 ©Mark Allison 2010
32. What is the point of
this?
It’s
not
about
how
to
stop
a
suicidal
patient
who
didn’t
reach
out...
but
how
to
prevent
a
potential
suicide
from
a
patient
who
tried
to
reach
out
or
presented
with
symptoms
and
warning
signs.
www.thebeverlyhillstherapist.com 12 ©Mark Allison 2010
33. Listen!
Our
job
as
therapists
is
to
be
listening
to
our
patients...
A
suicidal
patient
wants
to
be
heard...
LISTEN
www.thebeverlyhillstherapist.com 13 ©Mark Allison 2010
35. Empathy Vs. Sympathy
Sympathy
Kindness
of
feeling
toward
one
who
suffers;
pity;
commiseration;
compassion.
Empathy
The
ability
to
understand
and
share
the
feelings
of
another
‐Oxford
American
Dictionary
www.thebeverlyhillstherapist.com 14 ©Mark Allison 2010
37. Talking to Suicidal
Patients
Gathering
information
questions
should
be
interspersed
with
rapport
building
statements
Listen
to
the
answer,
follow
up
with
an
an
empathic
statement
when
appropriate
and
let
that
direct
your
next
question
Don’t
be
alarmed
by
their
thoughts
of
suicide
Model
discussing
it
openly
www.thebeverlyhillstherapist.com 15 ©Mark Allison 2010
38. Talking to suicidal
patients on the phone
www.thebeverlyhillstherapist.com 16 ©Mark Allison 2010
39. Talking to suicidal
patients on the phone
Listen
using
Active
Listening
skills.
The
suicidal
person
often
needs
to
be
heard
Refrain
from
saying,
“it’s
going
to
be
ok”
or
“tomorrow
will
be
a
new
day”
Avoid
searching
for
quick
solutions
Always
try
to
be
assessing
for
lethality.
Close
call
with
a
follow
up
assessment:
i.e.
“I’m
wondering
when
I
get
off
the
phone
what
you
plan
on
doing”
www.thebeverlyhillstherapist.com 16 ©Mark Allison 2010
40. Talking to suicidal
patients on the phone
www.thebeverlyhillstherapist.com 17 ©Mark Allison 2010
41. Talking to suicidal
patients on the phone
Empathic
voice,
try
to
voice
match
Use
open
ended
questions
(to
encourage
expression
of
feelings
and
to
build
rapport)
Ask
the
suicide
question
directly:
Ask
“Are
you
thinking
about
killing
yourself
tonight”
Rather
than,
“Are
you
thinking
about
doing
something”
www.thebeverlyhillstherapist.com 17 ©Mark Allison 2010
42. Lethality assessment
begins at intake
Read
through
your
completed
intake
before
your
first
session
with
patient.
Look
for
warning
signs
that
may
indicate
suicidal
risk.
www.thebeverlyhillstherapist.com 18 ©Mark Allison 2010
43. Open ended
questions
Closed
Ended
Caller:
I
just
can’t
take
it
anymore,
I
don’t
know
what
I
am
going
to
do
after
what
she
said
to
me
last
night
Therapist:
What
are
you
doing
to
do?
or
“Are
you
angry
at
someone?
www.thebeverlyhillstherapist.com 19 ©Mark Allison 2010
44. open ended
questions
Open
Ended
Caller:
“I
just
can’t
take
it
anymore,
I
feel
like
there
is
no
way
out”
Therapist:
“It
sounds
like
you
are
feeling
overwhelmed.
This
must
be
a
really
difficult
time
for
you
right
now.”
www.thebeverlyhillstherapist.com 20 ©Mark Allison 2010
45. closed ended
questions
When
would
we
ask
closed
ended
questions?
www.thebeverlyhillstherapist.com 21 ©Mark Allison 2010
46. closed ended
questions
When
would
we
ask
closed
ended
questions?
Lethality
Assessment:
www.thebeverlyhillstherapist.com 21 ©Mark Allison 2010
47. closed ended
questions
When
would
we
ask
closed
ended
questions?
Lethality
Assessment:
Are
you
thinking
about
killing
yourself?
www.thebeverlyhillstherapist.com 21 ©Mark Allison 2010
48. closed ended
questions
When
would
we
ask
closed
ended
questions?
Lethality
Assessment:
Are
you
thinking
about
killing
yourself?
How
were
you
planning
on
killing
yourself?
www.thebeverlyhillstherapist.com 21 ©Mark Allison 2010
49. closed ended
questions
When
would
we
ask
closed
ended
questions?
Lethality
Assessment:
Are
you
thinking
about
killing
yourself?
How
were
you
planning
on
killing
yourself?
Do
you
have
access
to
a
gun?
www.thebeverlyhillstherapist.com 21 ©Mark Allison 2010
51. flow and followup
Questions
should
flow
in
a
direction
Try
to
explore
one
area
at
a
time
Listen
to
the
clients’s
answer
before
preparing
your
next
question
Be
sensitive
to
how
your
question
may
be
perceived.
i.e.
“Have
you
always
be
so
depressed?”
www.thebeverlyhillstherapist.com 22 ©Mark Allison 2010
53. Warning signs
Expressing
suicidal
feelings
directly
or
bringing
up
the
topic
of
suicide
Giving
away
prized
possessions,
settling
affairs,
making
out
a
will
Signs
of
depression:
loss
of
pleasure
,
sad
mood,
alteration
in
sleeping/eating
patterns,
feelings
of
hopelessness
and
excessive
guilt
Change
of
behavior
(poor
work
or
school
performance)
Risk‐taking
behaviors
Increased
use
of
alcohol
or
drugs
Social
Isolation
www.thebeverlyhillstherapist.com 23 ©Mark Allison 2010
54. What’s The Number 1
Warning sign
www.thebeverlyhillstherapist.com 24 ©Mark Allison 2010
55. What’s The Number 1
Warning sign
Developing
a
specific
plan
for
suicide
This
is
the
NUMBER
ONE
predictor
of
suicide
risk!
www.thebeverlyhillstherapist.com 24 ©Mark Allison 2010
57. Risk factors
Having
attempted
suicide
in
the
past
Signs
of
depression,
prolong
sadness,
feelings
of
hopelessness,
deep
apathy
Eating
problems
Anguish
over
recent
loss
www.thebeverlyhillstherapist.com 25 ©Mark Allison 2010
59. Suicide Risk assessment
1. Are they thinking about killing themselves? (ask directly)
www.thebeverlyhillstherapist.com 26 ©Mark Allison 2010
60. Suicide Risk assessment
1. Are they thinking about killing themselves? (ask directly)
2. Do they have a plan? When?
www.thebeverlyhillstherapist.com 26 ©Mark Allison 2010
61. Suicide Risk assessment
1. Are they thinking about killing themselves? (ask directly)
2. Do they have a plan? When?
3. Do they have the means to commit suicide at their hands?
www.thebeverlyhillstherapist.com 26 ©Mark Allison 2010
62. Suicide Risk assessment
1. Are they thinking about killing themselves? (ask directly)
2. Do they have a plan? When?
3. Do they have the means to commit suicide at their hands?
4. Are they alone?
www.thebeverlyhillstherapist.com 26 ©Mark Allison 2010
63. Suicide Risk assessment
1. Are they thinking about killing themselves? (ask directly)
2. Do they have a plan? When?
3. Do they have the means to commit suicide at their hands?
4. Are they alone?
5. Have they been drinking or intoxicated (drugs street or prescription)
www.thebeverlyhillstherapist.com 26 ©Mark Allison 2010
64. Suicide Risk assessment
1. Are they thinking about killing themselves? (ask directly)
2. Do they have a plan? When?
3. Do they have the means to commit suicide at their hands?
4. Are they alone?
5. Have they been drinking or intoxicated (drugs street or prescription)
6. Have they ever attempted to kill themselves before
www.thebeverlyhillstherapist.com 26 ©Mark Allison 2010
65. Suicide Risk assessment
1. Are they thinking about killing themselves? (ask directly)
2. Do they have a plan? When?
3. Do they have the means to commit suicide at their hands?
4. Are they alone?
5. Have they been drinking or intoxicated (drugs street or prescription)
6. Have they ever attempted to kill themselves before
7. Is there a gun in the home? Number 1 method for completed suicides
www.thebeverlyhillstherapist.com 26 ©Mark Allison 2010
66. Suicide Risk assessment
1. Are they thinking about killing themselves? (ask directly)
2. Do they have a plan? When?
3. Do they have the means to commit suicide at their hands?
4. Are they alone?
5. Have they been drinking or intoxicated (drugs street or prescription)
6. Have they ever attempted to kill themselves before
7. Is there a gun in the home? Number 1 method for completed suicides
8. Family History of suicide and/or depression
www.thebeverlyhillstherapist.com 26 ©Mark Allison 2010
67. Suicide Risk assessment
1. Are they thinking about killing themselves? (ask directly)
2. Do they have a plan? When?
3. Do they have the means to commit suicide at their hands?
4. Are they alone?
5. Have they been drinking or intoxicated (drugs street or prescription)
6. Have they ever attempted to kill themselves before
7. Is there a gun in the home? Number 1 method for completed suicides
8. Family History of suicide and/or depression
9. Medications
www.thebeverlyhillstherapist.com 26 ©Mark Allison 2010
68. Suicide Risk assessment
1. Are they thinking about killing themselves? (ask directly)
2. Do they have a plan? When?
3. Do they have the means to commit suicide at their hands?
4. Are they alone?
5. Have they been drinking or intoxicated (drugs street or prescription)
6. Have they ever attempted to kill themselves before
7. Is there a gun in the home? Number 1 method for completed suicides
8. Family History of suicide and/or depression
9. Medications
10.Mental illness
www.thebeverlyhillstherapist.com - Diagnosis 26 ©Mark Allison 2010
69. Suicide
ESIRE AP ABILITY risk
Ideation
Psych Pain
Priors Attempts
Available Means
assessment
Hopeless/Helpless Survivor
Burden Violence
Trapped Intoxicated/Sub. Abuse
Alone Mood Change/Out of Touch
Anxiety/Insomnia
NTENT UFFERS
Specific Plan Immediate Supports
Preparatory Behaviors Social Supports
Intent To Die - Planning For The Future
Engaged With Counselor
Ambivalence For Life/Death
Core Values/Beliefs
Sense Of Purpose
www.thebeverlyhillstherapist.com 27 ©Mark Allison 2010
70. assessment tool
Desire
www.thebeverlyhillstherapist.com 28 ©Mark Allison 2010
71. assessment tool
Desire
Suicidal
Ideation
Psychological
Pain
Feeling
Trapped
Feeling
Alone
Hopelessness
Helplessness
www.thebeverlyhillstherapist.com 28 ©Mark Allison 2010
72. assessment tool
Capability
www.thebeverlyhillstherapist.com 29 ©Mark Allison 2010
73. assessment tool
Capability
Previous
Attempts
Exposure
to
Someone’s
Else’s
Suicide
Violence
(past
or
present)
Availability
of
Means
Currently
Intoxicated
Substance
Abuse
www.thebeverlyhillstherapist.com 29 ©Mark Allison 2010
74. assessment tool
Capability
www.thebeverlyhillstherapist.com 30 ©Mark Allison 2010
75. assessment tool
Capability
Mood
Change
Anxiety
Decreased
Sleep
Out
of
Touch
www.thebeverlyhillstherapist.com 30 ©Mark Allison 2010
76. assessment tool
Intent
www.thebeverlyhillstherapist.com 31 ©Mark Allison 2010
77. assessment tool
Intent
Suicide
Plan
Preparatory
Behaviors
Expressed
Intent
to
die
www.thebeverlyhillstherapist.com 31 ©Mark Allison 2010
78. assessment tool
Buffers/connectedness
www.thebeverlyhillstherapist.com 32 ©Mark Allison 2010
79. assessment tool
Buffers/connectedness
Immediate
Supports
Social
Supports
Engagement
Core
Values
and
Beliefs
Sense
of
Purpose
www.thebeverlyhillstherapist.com 32 ©Mark Allison 2010
80. assessment tool
Buffers/connectedness
www.thebeverlyhillstherapist.com 33 ©Mark Allison 2010
81. assessment tool
Buffers/connectedness
Future
Plans
Ambivalence
for
Living/Dying
www.thebeverlyhillstherapist.com 33 ©Mark Allison 2010
83. Risk Assessment
Is
there
a
“message”
that
they
are
sending
by
their
suicide?
Is
there
any
desired
outcome
(reunion
with
deceased
relatives,
guilty
feelings
reduced
or
engendered,
burden
being
lifted)?
www.thebeverlyhillstherapist.com 34 ©Mark Allison 2010
85. Lethality assessment
summary
1. Ask
directly
are
they
having
thoughts
about
killing
themselves
2. Do
they
have
a
plan?
How
specific
is
it?
When?
3. Is
there
access
to
the
means?
4. Have
they
thought
about
suicide
in
the
past
2
months?
5. Are
they
drinking/under
the
influence?
6. Recent
or
prior
attempts?
7. Are
they
alone?
8. Family
history
of
suicide
and
or
depression?
9. Mental
Illness
(Major
Depression
Disorder,Bi‐polar
etc)?
10.Are
they
on
any
medications?
11.Do
they
have
a
gun
or
access
to
a
gun?
www.thebeverlyhillstherapist.com 35 ©Mark Allison 2010
86. Interventions
Start
with
the
least
intrusive
intervention
first
www.thebeverlyhillstherapist.com 36 ©Mark Allison 2010
87. Interventions
“No
Suicide”
Contract
Increased
client
contact
Collaborative
“Action
Plan”
Organize
a
24‐hour
suicide
watch
among
family
and
friends
Help
to
arrange
for
a
voluntary
hospitalization
Initiate
involuntary
hospitalization
(5150)
www.thebeverlyhillstherapist.com 37 ©Mark Allison 2010
88. Vignettes
Questions
www.thebeverlyhillstherapist.com 38 ©Mark Allison 2010
89. concluding
thoughts
Develop
understanding
and
trust
Listen
for
words
and
feelings
that
indicate
suicidal
thoughts.
Assess
for
suicide
using
suicide
risk
assessment
technique
Develop
direction
and
focus
www.thebeverlyhillstherapist.com 39 ©Mark Allison 2010
92. Role Play
Question
Period
Conclusion
www.thebeverlyhillstherapist.com 41 ©Mark Allison 2010
Editor's Notes
Legal precedents have established that therapist must take “reasonable steps” to ensure the safety of suicidal clients
Legal precedents have established that therapist must take “reasonable steps” to ensure the safety of suicidal clients
Legal precedents have established that therapist must take “reasonable steps” to ensure the safety of suicidal clients
Legal precedents have established that therapist must take “reasonable steps” to ensure the safety of suicidal clients
Legal precedents have established that therapist must take “reasonable steps” to ensure the safety of suicidal clients
Legal precedents have established that therapist must take “reasonable steps” to ensure the safety of suicidal clients
Legal precedents have established that therapist must take “reasonable steps” to ensure the safety of suicidal clients
Additional High Risk Groups: Gay teens, then male over 59, then teenage boys
Additional High Risk Groups: Gay teens, then male over 59, then teenage boys
Initiate a 5150 but not Invoke one.
I don’t believe we should instill hope to our patients by telling generic positive affirmations... but through active listening skills, such as reflection, and summeriation we can first show the patient that we are actually listening to them and understand them. Then we can co-create a plan of action to safety.
I don’t believe we should instill hope to our patients by telling generic positive affirmations... but through active listening skills, such as reflection, and summeriation we can first show the patient that we are actually listening to them and understand them. Then we can co-create a plan of action to safety.
I don’t believe we should instill hope to our patients by telling generic positive affirmations... but through active listening skills, such as reflection, and summeriation we can first show the patient that we are actually listening to them and understand them. Then we can co-create a plan of action to safety.
I don’t believe we should instill hope to our patients by telling generic positive affirmations... but through active listening skills, such as reflection, and summeriation we can first show the patient that we are actually listening to them and understand them. Then we can co-create a plan of action to safety.
I don’t believe we should instill hope to our patients by telling generic positive affirmations... but through active listening skills, such as reflection, and summeriation we can first show the patient that we are actually listening to them and understand them. Then we can co-create a plan of action to safety.
I don’t believe we should instill hope to our patients by telling generic positive affirmations... but through active listening skills, such as reflection, and summeriation we can first show the patient that we are actually listening to them and understand them. Then we can co-create a plan of action to safety.