1. Basic Elements of Suicide Risk Management and Crisis Management

2. Basic Elements of Suicide Risk Management
First Objective – Ensure Safety (Immediate Response)
Supervision
Means Restriction
Communication with team
Document in eCET
Self-explanatory

3. Basic Elements of Suicide Risk Management
Second Objective – Decrease Suicidal State and Stabilization
Pharmacologic interventions – perturbation
Physical Care
HALT
Warm, nurturing, safe, calm environment
Address any underlying medical conditions
Psychosocial Support
Clean and Sober
Frequent reevaluation of suicidality
Focus is on state variables discussed earlier

4. Basic Elements of Suicide Risk Management
Third Objective – Treatment of Longer Term Variables
Treat underlying mental disorders
Decrease risk factors
Increase protective factors
Increase coping skills
Frequent reevaluation of suicidality
Focus is on trait variables

5. Basic Elements of Suicide Risk Management
Fourth Objective – Preparation for discharge
Parent/Family Education
Warning signs
Community resources (24/7)
Means restriction
Medication management and education
Relapse prevention (e.g. AA)
Follow-up plan
This is where programs may miss the boat. It is critical to educate parents that if they do not make sure that their children stay on their medication and in treatment, that depending upon the child’s diagnosis, their child may have up to a 20% chance of dying by suicide.

6. Suicide Postvention

7. Suicidal Crisis Episode
Risk is Imminent 7 6 5 3 2 1
Risk
Level 4
Initial Hazard
is Encountered
Set up to the following slide  Cluster Effect
In the case of a suicidal episode we would hope that this would be the pattern that follows.
After the peak of a crisis the risk level would come back down to stable; however without intervention a cluster effect could develop
Crisis
Begins
Crisis
Peaks
Crisis
Diminishes
Stable
Stable
Years
Days
Hours
Days
Years
Approximately 3 weeks

8. Cluster Effect
Duration and Intensity
of Risk Factors Increases
(2nd and 3rd suicides occur)
Secondary Hazard Occurs
(e.g. anniversary date)
Risk Continues
to Increase
First Suicide
Occurs
Very
High
Risk
Initial Hazard
Encountered
Crisis
Continues
Higher
Risk
Crisis
Builds
Crisis
Remains
High
Risk
Risk
Continues
Crisis
Begins
Self-explanatory
Stable
Years
Hours
Days
Weeks
Mos/Yrs
Days
Weeks
Months
Months
Due to mounting losses, increasing frequency of anniversary dates,
role-modeling effects, and building stress, the risk for additional
suicides can remain present for months and even years.
VW/1998

9. Crisis Response Plans
Procedural document that details staff responsibilities in the event of a completed suicide or a life threatening attempt
Rationale:
Importance of an “affectively calm” environment
Reduce risk of suicide clusters
Help staff, clients and families cope
Avoid unnecessary litigation

10. Crisis Response Plans Content Staff must be trained!
First responder duties
Safety of clients
Needs of unit
Needs of staff
Needs of families
Reporting and documentation requirements
Management of outside contacts
QI and periodic review
Staff must be trained!
*Review center’s Crisis Response Plan

11. Next Steps…
After today, everyone who completes the QPRT training will need to:
1. Read the QPRT manual
2. Conduct three QPRT assessments for review
3. Attend a QPR training if you have not done so
All trainees need to conduct three QPRT assessments for review.
Two can be on a clients who have minimal or no known risk, but the other must be a client who demonstrates moderate to high risk.