Working With Suicidal Patients

4,556 views
4,427 views

Published on

"Working With Suicidal Patients" was a workshop I presented for The Maple Counseling Center in Beverly Hills, CA.
Please feel free to view or download. -Mark Allison

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
4,556
On SlideShare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
131
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
















  • 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.





























































  • Working With Suicidal Patients

    1. 1. 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. 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. 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
    4. 4. www.thebeverlyhillstherapist.com 4 ©Mark Allison 2010
    5. 5. what the bleep do you know about suicide! 1. More women than men attempt suicide? www.thebeverlyhillstherapist.com 4 ©Mark Allison 2010
    6. 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. 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. 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. 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. 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. 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. 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. 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. 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
    15. 15. www.thebeverlyhillstherapist.com 5 ©Mark Allison 2010
    16. 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. 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. 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. 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. 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. 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
    22. 22. www.thebeverlyhillstherapist.com 6 ©Mark Allison 2010
    23. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
    34. 34. Empathy Vs. Sympathy www.thebeverlyhillstherapist.com 14 ©Mark Allison 2010
    35. 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
    36. 36. Talking to Suicidal Patients www.thebeverlyhillstherapist.com 15 ©Mark Allison 2010
    37. 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. 38. Talking to suicidal patients on the phone www.thebeverlyhillstherapist.com 16 ©Mark Allison 2010
    39. 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. 40. Talking to suicidal patients on the phone www.thebeverlyhillstherapist.com 17 ©Mark Allison 2010
    41. 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. 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. 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. 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. 45. closed ended questions When
would
we
ask
closed
ended
questions? www.thebeverlyhillstherapist.com 21 ©Mark Allison 2010
    46. 46. closed ended questions When
would
we
ask
closed
ended
questions? Lethality
Assessment:

 www.thebeverlyhillstherapist.com 21 ©Mark Allison 2010
    47. 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. 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. 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
    50. 50. flow and followup www.thebeverlyhillstherapist.com 22 ©Mark Allison 2010
    51. 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
    52. 52. Warning signs www.thebeverlyhillstherapist.com 23 ©Mark Allison 2010
    53. 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. 54. What’s The Number 1 Warning sign www.thebeverlyhillstherapist.com 24 ©Mark Allison 2010
    55. 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
    56. 56. Risk factors www.thebeverlyhillstherapist.com 25 ©Mark Allison 2010
    57. 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
    58. 58. Suicide Risk assessment www.thebeverlyhillstherapist.com 26 ©Mark Allison 2010
    59. 59. Suicide Risk assessment 1. Are they thinking about killing themselves? (ask directly) www.thebeverlyhillstherapist.com 26 ©Mark Allison 2010
    60. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 70. assessment tool Desire www.thebeverlyhillstherapist.com 28 ©Mark Allison 2010
    71. 71. assessment tool Desire Suicidal
Ideation Psychological
Pain Feeling
Trapped Feeling
Alone Hopelessness Helplessness www.thebeverlyhillstherapist.com 28 ©Mark Allison 2010
    72. 72. assessment tool Capability www.thebeverlyhillstherapist.com 29 ©Mark Allison 2010
    73. 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. 74. assessment tool Capability www.thebeverlyhillstherapist.com 30 ©Mark Allison 2010
    75. 75. assessment tool Capability Mood
Change Anxiety Decreased
Sleep Out
of
Touch www.thebeverlyhillstherapist.com 30 ©Mark Allison 2010
    76. 76. assessment tool Intent www.thebeverlyhillstherapist.com 31 ©Mark Allison 2010
    77. 77. assessment tool Intent Suicide
Plan Preparatory
Behaviors Expressed
Intent
to
die www.thebeverlyhillstherapist.com 31 ©Mark Allison 2010
    78. 78. assessment tool Buffers/connectedness www.thebeverlyhillstherapist.com 32 ©Mark Allison 2010
    79. 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. 80. assessment tool Buffers/connectedness www.thebeverlyhillstherapist.com 33 ©Mark Allison 2010
    81. 81. assessment tool Buffers/connectedness Future
Plans Ambivalence
for
Living/Dying www.thebeverlyhillstherapist.com 33 ©Mark Allison 2010
    82. 82. Risk Assessment www.thebeverlyhillstherapist.com 34 ©Mark Allison 2010
    83. 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
    84. 84. Lethality assessment summary www.thebeverlyhillstherapist.com 35 ©Mark Allison 2010
    85. 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. 86. Interventions Start
with
the
least
intrusive
intervention
first www.thebeverlyhillstherapist.com 36 ©Mark Allison 2010
    87. 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. 88. Vignettes Questions www.thebeverlyhillstherapist.com 38 ©Mark Allison 2010
    89. 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
    90. 90. A Good referral www.thebeverlyhillstherapist.com 40 ©Mark Allison 2010
    91. 91. A Good referral www.thebeverlyhillstherapist.com 40 ©Mark Allison 2010
    92. 92. Role Play Question
Period Conclusion www.thebeverlyhillstherapist.com 41 ©Mark Allison 2010
    93. 93. End www.thebeverlyhillstherapist.com 42 ©Mark Allison 2010

    ×