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Crisis Intervention with Potentially Dangerous Individuals Working with clients who pose a danger to either themselves or other people.

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Presentation on theme: "Crisis Intervention with Potentially Dangerous Individuals Working with clients who pose a danger to either themselves or other people."— Presentation transcript:

1 Crisis Intervention with Potentially Dangerous Individuals Working with clients who pose a danger to either themselves or other people.

2 Suicide: Facts & Figures 25,000-50,000 Americans commit suicide every year. Suicide may be more common than homicide.25,000-50,000 Americans commit suicide every year. Suicide may be more common than homicide. 300,00-600,000 suicide attempts annually; 15% of those who attempt suicide will eventually succeed.300,00-600,000 suicide attempts annually; 15% of those who attempt suicide will eventually succeed. Attempt to complete ratio is approximately 10:1.Attempt to complete ratio is approximately 10:1. 1/3 of Americans will experience suicidal ideation during their lifetimes.1/3 of Americans will experience suicidal ideation during their lifetimes. Most common methods of attempting suicide: overdosing (80%) followed by cutting wrists (10%).Most common methods of attempting suicide: overdosing (80%) followed by cutting wrists (10%). Most lethal method: firearms (60% of completed suicides).Most lethal method: firearms (60% of completed suicides).

3 Males are 4-5x’s more likely than females to complete suicide; females are more likely than males to make non-lethal attempts.Males are 4-5x’s more likely than females to complete suicide; females are more likely than males to make non-lethal attempts. Highest Demographic Risk: White males over age 65.Highest Demographic Risk: White males over age % of those who complete suicide had previously communicated this intention to another person.80% of those who complete suicide had previously communicated this intention to another person. As many as 15% of clients with chronic depression or alcohol dependence will eventually commit suicide; 10% rate for those with BPD or schizophrenia.As many as 15% of clients with chronic depression or alcohol dependence will eventually commit suicide; 10% rate for those with BPD or schizophrenia.

4 Alcohol is involved in 15-50% of suicide attempts.Alcohol is involved in 15-50% of suicide attempts. Most people who commit suicide were experiencing a mental disorder at the time.Most people who commit suicide were experiencing a mental disorder at the time % of mental health professionals will lose a client to suicide.20-50% of mental health professionals will lose a client to suicide.

5 Risk Factors & Warning Signs Direct verbal warnings.Direct verbal warnings. Suicidal Ideation or Plans.Suicidal Ideation or Plans. Family History.Family History. Prior hx. of self- destructive behavior.Prior hx. of self- destructive behavior. Prior psychiatric hospitalization.Prior psychiatric hospitalization. Chronic physical illness.Chronic physical illness. Depression: especially hopelessness & insomnia.Depression: especially hopelessness & insomnia. Personality Disorder.Personality Disorder. Recent loss (divorce, unemployment). Alcohol & drug problems. Finalizing one’s affairs. Lack of social support. Poor impulse control. Tunnel vision. Poor problem-solving skills.

6 Psychological Intent for Suicide 1.Hopeless Suicide: pessimistic view that life is unbearable & will not get any better; view suicide as the only solution. 2.Psychotic Suicide: tired of battling a chronic, psychotic disorder; person may also experience command hallucinations & delusions. 3.Rational Suicide: view suicide as a reasonable solution to a terminal illness; desire relief from current or future suffering. 4.Impulsive/Histrionic Suicide: driven by a desire for attention, revenge, or stimulation; they hope attempt will change other people’s behavior toward them.

7 Level of Dangerousness

8 Assessing Suicide: Funneling 1.Complete thorough assessment: focus on risk factors, mood, psychiatric history, A & D use, support system, & outlook on the future. 2.Inquire specifically about past and present suicidal ideation, plans, or attempts.

9 3.If suicide is a concern, obtain additional information: Frequency/intensity of thoughts.Frequency/intensity of thoughts. Specificity & lethality of plan.Specificity & lethality of plan. Availability of means.Availability of means. Probability of rescue.Probability of rescue. Expectation of attempt.Expectation of attempt. Identify barriers (reasons to live) or resources that might prevent suicide. “What has stopped you from committing suicide?”Identify barriers (reasons to live) or resources that might prevent suicide. “What has stopped you from committing suicide?”

10 Example Questions (Zuckerman, 1995) “Has it crossed your mind that death would relieve you or end your pain?”“Has it crossed your mind that death would relieve you or end your pain?” “Have you felt ‘my life is a failure’ or ‘my situation is hopeless’?”“Have you felt ‘my life is a failure’ or ‘my situation is hopeless’?” “Have you thought about how you might kill yourself?”“Have you thought about how you might kill yourself?” “Have you made any plans to hurt or kill yourself?”“Have you made any plans to hurt or kill yourself?” “What would prevent you from killing yourself?“What would prevent you from killing yourself?

11 Overdosing Frequently Used Drugs Anxiolytics & Sleeping Pills.Anxiolytics & Sleeping Pills. Tricyclic Antidepressants (e.g., Elavil).Tricyclic Antidepressants (e.g., Elavil). Aspirin.Aspirin. Acetaminophen (i.e., Tylenol).Acetaminophen (i.e., Tylenol). As a very general rule of thumb, 10x’s a normal dose of a dangerous drug is lethal.As a very general rule of thumb, 10x’s a normal dose of a dangerous drug is lethal.

12 Special Issues with Adolescents Suicide rate among adolescents has increased in recent years, but continues to be lower than adult rates.Suicide rate among adolescents has increased in recent years, but continues to be lower than adult rates. Reluctance to confide in adults; collateral information can be very valuable.Reluctance to confide in adults; collateral information can be very valuable. Younger adolescents may not fully understand the irreversibility of death.Younger adolescents may not fully understand the irreversibility of death. “Personal Fable” Mentality.“Personal Fable” Mentality.

13 Intervention Strategies  Develop a crisis management plan, including emergency procedures.  Remove dangerous objects (guns, pills).  Develop a Care Team to monitor client at home.  Consider hospitalization, psychiatric consultation, or intensifying treatment.  Closely monitor care.

14 ....  Work with client’s strengths & reasons for living.  Help client identify specific alternatives to ending his or her life.  Improve problem solving & coping skills.

15 No-Harm Contracts: Objective: client makes a commitment to not harm himself for a specific period of time.Objective: client makes a commitment to not harm himself for a specific period of time. Components:Components: 1.Emergency contact numbers. 2.Steps to follow in the event of an emergency (e.g., call crisis line, go to ER). 3.Prevention Plan, include practical coping skills. 4.Identify who can provide social support.

16 Self-Mutilation & Other Parasuicidal Behaviors Definition: inflicting harm on one’s body without any intention of death or serious injury.Definition: inflicting harm on one’s body without any intention of death or serious injury. Typical sufferer: young female (15-25) with a history of childhood abuse or neglect.Typical sufferer: young female (15-25) with a history of childhood abuse or neglect. Manifestation: (1) scratching, cutting or burning one’s arms, wrists, face, legs, genitals, etc.; or (2) preventing wounds from healing.Manifestation: (1) scratching, cutting or burning one’s arms, wrists, face, legs, genitals, etc.; or (2) preventing wounds from healing. Co-Morbid Problems: eating disorders, mood disorders, BPD, & chemical dependency.Co-Morbid Problems: eating disorders, mood disorders, BPD, & chemical dependency.

17 Duration: chronic & compulsive course lasting years.Duration: chronic & compulsive course lasting years. Ironically, sufferers typically feel little pain while engaging in self-mutilation.Ironically, sufferers typically feel little pain while engaging in self-mutilation.

18 Why do people self-mutilate? 1.Tension reduction. 2.Coping with negative emotions (e.g., turn emotional pain into physical pain). 3.Interpersonal communication (e.g., manipulation). 4.Atonement for perceived sins. 5.Hatred toward one’s body or sexuality. 6.Self-stimulation (“to feel something”). 7.Feel more powerful & in control of one’s life. 8.Psychosis.

19 Coping Strategies to Reduce Self-Mutilation: Engage in non-harmful sensation-seeking (e.g., submerge arm in ice water).Engage in non-harmful sensation-seeking (e.g., submerge arm in ice water). Destroy something non-living & invaluable.Destroy something non-living & invaluable. Use a red marker rather than a knife.Use a red marker rather than a knife. Response Prevention.Response Prevention. Direct verbal expression of feelings.Direct verbal expression of feelings. Distraction.Distraction. Social Engagement.Social Engagement. Physical movement or Exercise.Physical movement or Exercise. Relaxation TechniquesRelaxation Techniques

20 Potentially Violent Clients: Risk Factors History of violent or impulsive behavior.History of violent or impulsive behavior. Family conflict.Family conflict. Low frustration tolerance.Low frustration tolerance. Former or current legal issues.Former or current legal issues. A & D Use.A & D Use. Plan for committing violence.Plan for committing violence. Means for carrying out violence.Means for carrying out violence.

21 Gravely Disabled Clients Responsibility to protect people who cannot care for themselves because of cognitive impairment.Responsibility to protect people who cannot care for themselves because of cognitive impairment. Examples: psychotic disorders, Alzheimer’s disease, dementia, or other organic brain disorders.Examples: psychotic disorders, Alzheimer’s disease, dementia, or other organic brain disorders.

22 Legal Issues: Legal duty to provide ordinary and reasonable care.Legal duty to provide ordinary and reasonable care. Negligence: unreasonable failure to adhere to professional standards.Negligence: unreasonable failure to adhere to professional standards. Objective Test: What would the average and reasonable helper of similar training and experience have done in the same or similar situation?Objective Test: What would the average and reasonable helper of similar training and experience have done in the same or similar situation?


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