working with suicidal patients
DESCRIPTION
This is a PDF file from powerpoint of a recent workshop I presented for The Maple Counseling Center on working with suicidal patients. Please feel free to download and use as a reference. -MarkTRANSCRIPT
www.thebeverlyhillstherapist.com
Working with
Suicidal Patients
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
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©Mark Allison 2010 www.thebeverlyhillstherapist.com
What we will cover in this
workshop
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©Mark Allison 2010 www.thebeverlyhillstherapist.com
History of Suicide
Prevention Hotlines
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©Mark Allison 2010 www.thebeverlyhillstherapist.com
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.
It’s one of the most helpful things you can do.4
©Mark Allison 2010 www.thebeverlyhillstherapist.com
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?
8. Young people who are suicidal often give warning signs
True, According to NAMI, it is highest in the western states...
True. 5
©Mark Allison 2010 www.thebeverlyhillstherapist.com
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 presenceof 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.
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facts and myths about Suicide
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©Mark Allison 2010 www.thebeverlyhillstherapist.com
facts and myths about Suicide
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facts and myths about Suicide
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facts and myths about Suicide
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©Mark Allison 2010 www.thebeverlyhillstherapist.com
Legal & Ethical Issues
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©Mark Allison 2010 www.thebeverlyhillstherapist.com
Legal & Ethical Issues
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What is the point of
this?
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Listen!
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Empathy Vs. Sympathy
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Talking to Suicidal
Patients
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©Mark Allison 2010 www.thebeverlyhillstherapist.com
Talking to suicidal
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©Mark Allison 2010 www.thebeverlyhillstherapist.com
Talking to suicidal
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Lethality assessment
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©Mark Allison 2010 www.thebeverlyhillstherapist.com
Open ended
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©Mark Allison 2010 www.thebeverlyhillstherapist.com
open ended
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closed ended
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flow and followup
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Warning signs
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What’s The Number 1
Warning sign
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Risk factors
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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 - Diagnosis
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Suicide
risk
assessment
ESIRE
Ideation Psych Pain Hopeless/Helpless Burden Trapped Alone
AP ABILITY
Priors Attempts Available Means Survivor Violence Intoxicated/Sub. Abuse Mood Change/Out of Touch Anxiety/Insomnia
NTENT
Specific Plan Preparatory Behaviors Intent To Die -
UFFERS
Immediate Supports Social Supports Planning For The Future Engaged With Counselor Ambivalence For Life/Death Core Values/Beliefs Sense Of Purpose
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D.C.I.B
©Mark Allison 2010 www.thebeverlyhillstherapist.com
assessment tool
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Desire
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assessment tool
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Capability
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assessment tool
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assessment tool
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Intent
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assessment tool
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Buffers/connectedness
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assessment tool
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Buffers/connectedness
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Risk Assessment
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Assessing the RiskG%(3##+##(&"#6O(+`3C"/+(+3-*(#+-$"%/(IY+#"&+O(H3534"1"$'O(E/$+/$(3/.(m,Q+&#J<(E)(3(C3^%&"$'(%)()3-$%&#("#(!"?*(%&(=%.+&3$+g!"?*O($*3$(-%C5%/+/$("#(5&+#+/$<(m3#+('%,&(&3$"/?(I)&%C(X($%(MJ(%/($*+()%11%7"/?(C%.+1(3/.('%,&(3##+##C+/$($&3"/"/?D
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T(o((((((pY+#"&+(3/.(E/$+/$q(%&(pY+#"&+(3/.(H3534"1"$'q(%&(pH3534"1"$'(3/.(E/$+/$q(
r(pi,C+&%,#(m,Q+&#q
cA
pH3534"1"$'(31%/+q(%&(pE/$+/$(B1%/+q(r(pi,C+&%,#(m,Q+&#q(
UgK(o(((pY+#"&+(31%/+q(5&+#+/$<(m,Q+&#(*30+(/%(#"?/"P-3/$("C53-$<(X(o((((((i%(C3&6#("/(Y+#"&+O(H3534"1"$'O(%&(E/$+/$(-3$+?%&"+#(
BiF(o(B##+##C+/$(i%$(F%##"41+
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Wednesday, October 13, 2010
©Mark Allison 2010 www.thebeverlyhillstherapist.com
Suicide Risk Assessment
Scale
%/#$24$3*,%F()@
+'I"2!"#$%&'(
C522$3&%J&&$#1&!1$*(8(*%K7'3%L%MN%O2)P%Q%+$'3)%
J;'(7'97$R$12$))$6%Q%H3&"0(*'&$6%Q%:53%(3%
O"5)$!5(*(6'7%C"##'36%O'775*(3'&("3)
+"6$2'&$!"#$%(')
F&"%&(B$$+C5$("/(>3#$(s+3&95+-")"-(F13/(t([N(!&#<@0".+/-+(%)(E/$+/$
9+0+&+(B?"$3$"%/gB/ "̀+$'gEC5,1#"0"$'(r(Y+5&+##+.E/$%`"-3$+.(G(
],/("/(!%C+
!"#$%*'+
+(3"2
9,"-".31(E.+3$"%/(%)(;3?,+(F13/F&"%&(B$$+C5$(>%/?+&(G*3/(c/+(s+3&(B?%
=+/$31(E11/+##_(%&(9,4#$3/-+(B4,#+A+13$"%/#*"5(F&%41+C#()%&(B?+#(XaKL:"/3/-"31(F&%41+C#()%&(B?+#(UXaV[
F*'#"-31(E11/+##()%&(B?+#(VMr
=3/'(9$&+##%&#
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©Mark Allison 2010 www.thebeverlyhillstherapist.com
Interventions
9$3&$(7"$*($*+(1+3#$("/$&,#"0+("/$+&0+/$"%/(P&#$
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©Mark Allison 2010 www.thebeverlyhillstherapist.com
Interventions
K<ei%(9,"-".+f(H%/$&3-$
U<E/-&+3#+.(-1"+/$(-%/$3-$
T<H%1134%&3$"0+(eB-$"%/(F13/f
[<c&?3/"u+(3(U[a*%,&(#,"-".+(73$-*(3C%/?()3C"1'(
3/.()&"+/.#
M<!+15($%(3&&3/?+()%&(3(0%1,/$3&'(*%#5"$31"u3$"%/
V<E/"$"3$+("/0%1,/$3&'(*%#5"$31"u3$"%/(IMKMXJ
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Wednesday, October 13, 2010
©Mark Allison 2010 www.thebeverlyhillstherapist.com
Lethality assessment
summary
K< B#6(."&+-$1'(3&+($*+'(*30"/?($*%,?*$#(34%,$(6"11"/?($*+C#+10+#
U< Y%($*+'(*30+(3(513/8((!%7(#5+-"P-("#("$8(2*+/8
T< E#($*+&+(3--+##($%($*+(C+3/#8
[< !30+($*+'($*%,?*$(34%,$(#,"-".+("/($*+(53#$(U((C%/$*#8
M< B&+($*+'(.&"/6"/?g,/.+&($*+("/l,+/-+8
V< A+-+/$(%&(5&"%&(3$$+C5$#8
W< B&+($*+'(31%/+8
N< :3C"1'(*"#$%&'(%)(#,"-".+(3/.(%&(.+5&+##"%/8
L< =+/$31(E11/+##(I=3^%&(Y+5&+##"%/(Y"#%&.+&Om"a5%13&(+$-J8
KX<B&+($*+'(%/(3/'(C+."-3$"%/#8
KK<Y%($*+'(*30+(3(?,/(%&(3--+##($%(3(?,/8
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©Mark Allison 2010 www.thebeverlyhillstherapist.com
Vignettes
k,+#$"%/#
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©Mark Allison 2010 www.thebeverlyhillstherapist.com
concluding
thoughts
Y+0+1%5(,/.+&#$3/."/?(3/.($&,#$
>"#$+/()%&(7%&.#(3/.()++1"/?#($*3$("/."-3$+(
#,"-".31($*%,?*$#<
B##+##()%&(#,"-".+(,#"/?(#,"-".+(&"#6(
3##+##C+/$($+-*/"d,+
Y+0+1%5(."&+-$"%/(3/.()%-,#
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Wednesday, October 13, 2010
©Mark Allison 2010 www.thebeverlyhillstherapist.com
Suicide Prevention
Hotline
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©Mark Allison 2010 www.thebeverlyhillstherapist.com
Role Play
k,+#$"%/(F+&"%.
H%/-1,#"%/
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©Mark Allison 2010 www.thebeverlyhillstherapist.com
End
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Wednesday, October 13, 2010