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Suicide Assessment of When to Seek Emergency Intervention

Suicide Assessment of When to Seek Emergency Intervention

With several recent celebrity suicides, there is more and more focus on suicide assessment, prevention and intervention. This means that more clients will be coming to see a therapist, and they may have suicidal ideation. It puts the onus on the therapist to accurately assess the situation, and know when finances need to take a backseat, and when to get help for a client immediately. Here are some things to understand and get an accurate picture of, so that you can correctly assess when to get emergency services for a client that may be in a suicidal crisis. 

Have they attempted suicide before? As you already know, the biggest predictor of future behavior is past behavior; people are bound to repeat themselves. If they have already crossed that line of attempting to take their own life, even if it was just taking a couple baby aspirin, if they thought they were taking their own life, it does not matter how lethal the attempt was. The fact that they have a relationship with suicide already puts them at much higher risk and they should be treated with more seriousness than other clients when they report suicidal ideation. 

Do they have a plan? This means a thought-out plan, like they have put time and effort into the act. To look at it another way, if you have spent time online researching your vacation, finding the best rates, booking your flights a year in advance, calling around to local places you want to see and booking tours, while another person thought about going on vacation and had a couple ideas of what they wanted to do but was not sure which one to go with, who do you think is likely to go on vacation? The more time and effort spent into planning their suicide again increases the risk factor and should help guide your decision to access emergency services for them. 

Do they think about suicide? Do they have thoughts about suicide? What is their relationship with suicide like? Is it what keeps them going, knowing they have a way out? While people may feel desperate and hopeless, there is another line that some do not cross, and thinking about suicide and beginning a relationship with it adds to their risk profile.  

Do they have a history of mental illness or addiction? Adding to the stigma of mental illness and addiction is not the purpose of this, just helping you create an accurate clinical picture of who is in front of you, so that you can get emergency help if you need to. People with a history of mental illness and addiction are often more vulnerable to suicide than those without a history of it. Your assessment should contain information on their history with mental illness and addiction and will help you understand their risk of suicide better. 

Are they feeling alone and disconnected from others? Feeling cut off, isolated, and alone in life can add to feelings of despair and depression, making what may be tolerable sadness intolerable and provoking a suicidal crisis. Now to be clear, this is from the point of view of the client; it does not matter that you as a professional can see 20 people they have in their life that they can turn to on a moment's notice. If they feel alone and like they have no one, that is reality for them. Feeling alone and isolated adds to suicidal risk factor. 

Are they feeling hopeless/purposeless? This is more about how they view their future; do they have a reason to go on? Do they think things can get better or that there are options for them? People can actually handle a lot of stress if they feel like things can and will get better, or like there is a reason for them to do so. If they do not feel like there is hope or there is no point to their suffering, then that is when they are at greater risk of suicide, and intervention should be sought if they are thinking about suicide as their way out. 

Now there is no one test or question you can ask someone to let you know if they are at risk of suicide. You can ask the best questions in the world and get all the information you want, and you still may miss something. That is why the last thing to do is trust your instinct as a clinician. Sometimes if you have a bad feeling about something, there is a reason for it that you are not conscious of yet, so follow that instinct and start planning like you have someone in front of you in crisis. Planning ahead may help you save a life. 

You are not the only line of defense against suicide. The police, mental health emergency services, crisis lines and other human services all work on the front lines to help prevent the tragedy of suicide. One option to be aware of is the National Suicide Prevention Lifeline. It is a national crisis line that routes people to the nearest crisis line in the network to them and is available free of charge 24/7. Please make your clients aware of this and other emergency services open to them so no one in a crisis has to try to figure out what to do or who to call. 



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Jason Simpkins
Posted on 06/09/2018 by Jason Simpkins

Jason Simpkins is a writer at Open Counseling. He is a clinical social worker in Michigan and is dedicated to having quality mental health care available to everyone. And as a University of Michigan graduate, he says a hearty, Go Blue!

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