This PowerPoint is a companion to The Ethics and Psychology Podcast #25: The Assessment, Management, and Treatment of Suicidal Patients. Dr. John Gavazzi speaks with Dr. Sam Knapp about assessing, managing and treating the suicidal patient. Please read the disclaimer and the note on competence in dealing with suicidal patients. The podcast or video meets the requirements for Pennsylvania Act 74 requirements for all mental health professionals in Pennsylvania.

1. The Assessment, Management,
and Treatment of Suicidal
Patients
Ethics and Psychology Podcast
Episode #25
Hosted by Dr. John Gavazzi, Psychologist
Board Certified in Clinical Psychology
Dr_Gavazzi www.ethicalpsychology.com

2. This podcast fulfills Act 74
requirements for Pennsylvania
licensed psychologists, social
workers, marriage and family
therapists, and professional
counselors.

3. The Assessment, Management,
and Treatment of Suicidal
Patients
An Introductory Podcast
Special Guest:
Samuel J. Knapp, EdD, ABPP

4. Disclaimer
This podcast/video can only provide a basic introduction to the
assessment, management, and treatment of patients at risk to
die from suicide. As an educational program, it does not purport
to provide clinical or legal advice on any particular patient.
Participants with concerns about the assessment, management,
or treatment of any particular patient are urged to seek clinical
or legal advice. Also, individual psychotherapists need to use
their clinical judgment with particular patients and incorporate
procedures or techniques not covered in this podcast/video or
modify or omit certain recommendations herein because of the
unique needs of their patients.

5. A Note on Competence
A brief program of this nature can only highlight
some important facts about suicide assessment,
management, and intervention. It may serve as an
update or refresher for experienced clinicians.
However, competence in assessing, managing, or
treating suicidal patients can only come with more
extensive education and supervised experience.

6. Learning Objectives
At the end of this program the participants will
learn basic information that will help them to
1. Assess patients who are at risk to die from
suicide;
2. Manage the risks of suicide; and
3. Treat patients who are at risk to die from
suicide.

7. General Outline
Suicide is the 10th leading cause of death in the United
States and the most frequent crisis experienced by mental
health professionals.
This podcast/video reviews basic information about the
assessment, management, and treatment of patients at risk
to die from suicide.
It fulfills Act 74 requirements for Pennsylvania licensed
psychologists, social workers, marriage and family
therapists, and professional counselors.

8. Outline
• Assessment of Suicide
• Screening Instruments
• Suicide Management (4 M’s)
• Interventions
• Quality Enhancement Strategies

9. Assessment – Step 1
• Asking about suicidal thoughts, plans, and
intentions; does not increase risk.
• Needs to be part of an initial assessment
• If the patient denies current suicidal ideation,
plan, and intent, then can revisit later if needed.
• Important to ask about a history of suicidal
ideation, plans, and attempts.

10. Assessment – Step 1
• If a patient reports a low level of suicidal
ideation or history, then it may be appropriate to
continue with assessment.
• Passive versus active suicidal ideation
• About 4% of Americans will report SI in the past
year and about 1/3 of those with suicidal plan.

11. Assessment - Step 1
• Often, people with SI will deny it.
• Fear of hospitalization, negative appraisal of
psychologist, or actual desire to complete.
• If a patient denies suicidal ideation with other
risk factors, such as a history of attempts,
significant depressive symptoms, co-morbid
substance abuse, impulsivity, etc., move to the
second step.

12. Assessment - Step 2
• Effective helpers will interview in a respectful,
nonjudgmental and caring manner.
• Baseline Factors
• Acute Features
• Dynamic Variables
• Protective Factors

13. Baseline (static) Factors
• Age
• Race
• Gender
• Sexual Orientation
• Unemployment
• Lack of Access to
Healthcare
• Substance Abuse

14. Acute Factors
• Suicidal ideation
• Prior attempts
• Psychiatric History
• Recent stressors
• Medical
Conditions
• Lack of Support
• Access to means to
attempt suicide

15. Dynamic Variables
• Thwarted belongingness
• Perceived burdensomeness
• Emotional pain (mental illness)
• Physical illness (disability or pain)
• Guilt and/or moral challenges

16. Protective Factors
• Religious beliefs or affiliations
• Marriage
• Children
• Other support networks

17. Step Three: Screenings
• Columbia Suicide Screening Rating Scale
• Suicide Behavior Questionnaire – Revised
• Beck Hopelessness Scale
• Beck Suicide Ideation Scale (Pearson)

18. Balancing Factors
• Very difficult to predict which individuals will
act upon suicidal ideation
• Previous attempts single best predictor
• Detailed plans are at higher risk
• May want to quantify: low, medium, high risk

19. The Four M’s of Management
Motivate
Means
Medicate
Monitor

20. Motivation Tools
• Commitment to Life (Treatment) Agreement
• Reasons for living
• Avoid people, places, and things
• Symbols of hope
• How to manage distress
• Crisis numbers if needed

21. Means Restriction
• Details of suicide plan and remove
guns, medications, etc. away from
patient
• Patients seldom substitute one means
of suicide for another

22. Medication
• A management strategy for schizophrenia
or bipolar disorder
• Its effectiveness in reducing short-term
suicide risk in other patients is unclear
• Increased risk when starting or getting off
medication

23. Monitoring
• Continue to measure suicidal ideation and
plans
• Day-to-day check ins or monitoring with
patients consent may be indicated for
some patients
• Hospitalization in extreme cases

24. Quality Enhancement Strategies
The positive reframe on Risk
Management Strategies

25. Quality Enhancing Strategies
As the legal risks, the possibility of
treatment failure, or patient
complexity increases,
the greater the level of attention should
be given to quality enhancing
strategies.

26. Quality Enhancing Strategies
Consultation
Empowered Collaboration
Documentation
Redundant Protections

27. Consultation
 Technique oriented information
 Emotional reactions
 Reduction of emotional turmoil
 Thinking through solution together

28. Consultation
 Write down issues in advance
 Need to be open and honest
 Be willing to admit mistakes or clinical
errors

29. Empowered Collaboration
 Empowering psychologists respect a patient’s
autonomy and decision making skills about the
goals of treatment, process of treatment, and life
choices.
 Examples of tough decisions and ambivalent
patients

30. Documentation: Legal Purposes
 Required by insurers, State Board of Psychology,
APA Ethics Code, etc.
 A record of treatment for future providers
 Useful risk management tool
 Write out evaluation, decision-making steps,
consultations, and final decision

31. Redundant Protections
Multiple layers of information in order to provide
the highest level of care
 Another health care provider
 Psychological testing or screening device
 Family member or significant other
 Consultation

32. Why Redundant Protections?
Avoid errors in judgment
Obtain essential information
Promote greater chance of success
(Obtain prior records)

33. Suggested Checklist for Ongoing
Treatment
Patient Collaboration Self-Reflection
1. Does the patient think you have
a good working relationship?
2. Do my patient and me share the
same treatment goals?
3. Does the patient report any
progress in therapy?
4. Does the patient want to
continue in treatment?
1. Do I believe I have a positive
working relationship with my
patient?
2. Is my assessment of the patient
sufficiently comprehensive?
3. Do unresolved clinical issues
impede the course of treatment?
4. Have I documented
appropriately?

34. The End
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if you are looking for CE credit.
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Pennsylvania Psychological Association