The document discusses lethality assessments and crisis interventions, particularly in the context of suicidal ideation and risk evaluation. It outlines various factors that contribute to assessing someone's risk of suicide, emphasizes the importance of crisis intervention, and details the structured Robert's seven-stage model for crisis intervention. Case studies illustrate the assessment process and the intervention steps taken to support individuals in crisis.

1. LETHALITY
ASSESSMENT AND
CRISIS INTERVENTION
Aqsa shahid

2. 🠶 Lethality
"Lethality" refers to the capability or potential of causing death. It is commonly
used to describe the degree or extent to which something, such as a weapon,
disease, or substance, can cause fatal harm to living organisms, including
humans.
🠶 LethalityAssessment
Lethality assessment is a process used to evaluate the potential risk or danger
posed by an individual, typically in the context of interpersonal violence or self-
harm. It involves assessing various factors to determine the likelihood of a
person causing harm to themselves or others.

3. 🠶 Suicidal Ideation
Suicidal ideation refers to thoughts, fantasies, or preoccupations with the idea of taking
one's own life. It involves contemplating, planning, or fantasizing about suicide, even if
there is no immediate intention or plan to carry it out.
🠶 Crisis Intervention
Crisis intervention refers to a short-term and immediate form of psychological support
provided to individuals who are experiencing a crisis or facing an acute emotional or
mental health distress

4. Suicide Assessment Measures, Tools and
Guidelines
According to Roberts and Yeager (2009), if, during a suicide risk assessment, the person
exhibits any of the following fac- tors, it would seem prudent to call an ambulance; if the
patient is already at the emergency room, he or she should be further evaluated by a psychiatric
screener, psychiatric–mental health nurse, or psychiatric resident and hospitalized in a
psychiatric crisis stabilization unit for 48 to 72 hours of observation and evaluation.

5. 🠶 Patient expresses suicidal ideation: consider lethality and patient’s expectations, history of
attempts and lethality assessment, degree of ambivalence, wish to live and/or wish to die.
🠶 Patient has a suicide plan: presence or absence of rescue possibility.
🠶 Patient has access to lethal means and exhibits poor judgment.
🠶 Patient has access to available means, especially firearms.
🠶 Patient is agitated and exhibits imminent danger to self or others: assess for impulsivity,
degree of desperation, agitation.
🠶 Psychotic patient exhibits command hallucinations related to harming self or others.
🠶 Patient is intoxicated or high on illegal drugs and acting in an impulsive manner.
🠶 Family member reports on patient’s suicidal thoughts: of family concern indicates potential
risk

6. Additional key elements of assessment to be
considered include the following:
🠶 Psychosocial stressors
🠶 Support systems
🠶 Actual or perceived interpersonal losses
🠶 Financial difficulties or changes in socioeconomic status
🠶 Employment status
🠶 Cultural viewpoint
🠶 Religious viewpoint
🠶 Substance use—current and historical
🠶 Psychiatric history/diagnosis

7. It is recommend that every crisis counsellor, psychiatric screener, medical social
worker, psychiatric–mental health nurse, and psychiatrist be trained in the use of
these suicide assessment measures.
🠶 Beck Hopelessness Sale
🠶 Beck Depression Inventory
🠶 Beck Scale for Suicide Ideation
🠶 Columbia Suicide Severity Rating Scale
🠶 FirestoneAssessment of Self-Destructive Thoughts
🠶 Modified Scale for Suicide Ideation
🠶 Linehan Reasons for Living Scale
🠶 Self-Monitoring Suicide Ideation Scale
🠶 Scale for Suicide Ideation–Worst
🠶 Lifetime Parasuicidal Count
🠶 SADS Person Scale
🠶 Suicide Potential Lethality Scale

8. Person expresses Suicidal Ideation
Imminent Suicide
Risk
Moderate Suicide
Risk
Low Suicide Risk
Person has Specific Suicide Plan;
Access to Lethal Means;
Impaired Judgment; Psychosis
Or Other Serious Mental Illness
And/or Chemical Dependency-
Drug-Induced Psychosis; Poor
Social Support Network.
Person has No Access to Lethal
Means; Exhibits Fair or Good
Judgment; Has supportive family
or Significant Other;Agrees to
Sigh No-Harm Contract and more
importantly, to comply with
treatment recommendations
Person Exhibits No Suicide Plan
or Clear Intent Willing to Talk
About Stress & Problems, &
Depression; Willing to Seek
Treatment; Has Supportive
Significant Other and
Transportation.

9. Crisis intervention and suicide prevention include the following primary steps in an attempt to
prevent suicide:
🠶 Conduct a rapid lethality and biopsychosocial assessment.
🠶 Attempt to establish rapport and at the same time communicate a willingness to help the
caller in crisis. Help the caller in crisis to develop a plan of action that links him or her to
community health care and mental health agencies. The most frequent outcome of
depressed or suicidal callers is that they are transported to a psychiatric screening and
intake, a behavioral health care facility, a hospital, or an addiction treatment program.
🠶 The Robert Seven Stage Crisis Intervention Model provides a structured approach for
helping individuals in crisis to cope with their immediate problems and move toward
resolution.

11. CASE STUDIES

12. 1
.
Mr. H. is an extremely successful dentist practicing in the suburb of a Midwestern city. He is married
with three children, aged 12, 15, and 18. Although extremely successful, he has struggled with bipolar
disorder since he was 33; he is currently 50. He was referred to a substance abuse treatment facility for
alcohol dependence. This referral came following three successive complaints to the state medical board
stating that he smelled of alcohol. He admitted his abuse of alcohol and that, on the days of the complaints, he
had consumed drinks during lunch prior to returning to his practice in the afternoon. Mr. H. had
successfully completed detoxification and was in the 2nd week of his treatment when he demonstrated
symptoms of major depressive disorder, severe. He expressed extreme feelings of despair and depressed mood
nearly every day, loss of interest in almost all activities of the day, psychomotor agitation, fatigue,
hypersomnia, and excessive guilt about being “sick.” By the end of the 2nd week, he expressed suicidal
ideation, including a plan to kill himself with a gun, which he had access to while on a therapeutic leave from
the facility. This information was shared in a conversation with his business partner, who immediately called
the treating facility to alert it to this issue. The staff intervened, completing the first stage of Roberts’s seven-
stage model. In completing the lethality assessment, staff revealed a second, more pressing concern, which was
that H’s actual plan was to hang him- self in the bathroom of the halfway house that evening. As a result,
he was transferred to an inpatient psychiatric facility for a brief period of stabilization. During this time,
he expressed remorse for his actions, stating, “I would never kill myself.” He reported to staff that he had far
too much to live for and simply would not waste his life. H. worked diligently on his treatment plan,
participated in group and individual sessions, and completed goal work related to specific areas of needs,
including family therapy and addiction treatment.

13. Continue
With regard to suicidal ideation, he spoke openly in session with his family that he would not harm
himself. He agreed to complete a safety plan to protect against his suicidal ideation. He agreed to
have his gun collection removed from the house and spoke openly of future plans. After 4 days,
Mr. H. returned to the addiction treatment facility. He was admitted to the halfway house program.
After 2 weeks in the halfway house, He was granted a leave of absence. Harvey’s flight arrived in
his hometown at 6:00 p.m. At 8:00, Mr. H’s wife contacted the treatment facility, expressing concern
that he had not returned home. At 10:00 that evening H’s body was discovered at his office, the
apparent victim of death by asphyxiation. He was found in the dental patient chair in his office with
the nitrous oxide respirator on but without sufficient oxygen to support life. Although questions
were raised related to the possibility of accidental death, the autopsy indicated the presence of
sufficient lethal amounts of barbiturates in H’s system to facilitate overdose if asphyxiation had not
occurred

14. After reading H’s case synopsis and reviewing the suicide risk
assessment flow chart, would your preliminary rapid
assessment rate as at low, moderate, or high suicide risk?
Imminent Suicide
Risk
Moderate Suicide
Risk
Low Suicide Risk

15. Application of R-SSCIM:
 🠶 Stage 1: Assess Lethality
 🠶 Stage 2: Establish Rapport
 🠶 Stage 3: Identify the Main Problem, Including Crisis Precipitants or
Triggering Incidents
 🠶 Stage 4: Deal With Feelings and Emotions and Provide Support
 🠶 Stage 5: Explore Possible Alternatives
 🠶 Stage 6: Help Client and Formulate an Action Plan
 🠶 Stage 7: Follow-Up Phone Call, In-Person Appointment for Booster
Session, or Home Visit

16. 2
.
Mr. M’s mother reports that her 17-year-old daughter is barricaded in her bedroom
and last night destroyed her iPad and threw her cell phone into the hallway. M. has
not eaten for 24 hours. Her boyfriend broke up with her, and her mother has
heard her crying for many hours. She refuses to speak with her mother. The
mother is very worried because 8 months earlier, She had ingested a lot of
sleeping pills and been rushed to the emergency room when she was distraught
about the breakup with her previous boyfriend. A few hours ago, She called her
favorite first cousin and told him that she was giving him all of her music library.
M’s father, with whom she was very close, passed away 12 months ago from
cirrhosis of the liver. Her mother calls the psychiatric screening and crisis
intervention hotline at one of New Jersey’s large medical centers and indicates
that she thinks her daughter is depressed and possibly suicidal.

17. After reading M’s case synopsis and reviewing the suicide
risk assessment flow chart, would your preliminary rapid
assessment rate as at low, moderate, or high suicide risk?
Imminent Suicide
Risk
Moderate Suicide
Risk
Low Suicide Risk

18. Application of R-SSCIM:
 🠶 Stage 1: Assess Lethality
 🠶 Stage 2: Establish Rapport
 🠶 Stage 3: Identify the Main Problem, Including Crisis Precipitants or
Triggering Incidents
 🠶 Stage 4: Deal With Feelings and Emotions and Provide Support
 🠶 Stage 5: Explore Possible Alternatives
 🠶 Stage 6: Help Client and Formulate an Action Plan
 🠶 Stage 7: Follow-Up Phone Call, In-Person Appointment for Booster
Session, or Home Visit