1. Treatment and Management of Suicide Risk: Available Treatments
Treatment Plan
Safety Plan
No-Suicide Contracts
Engaging Third Parties
Psychotherapy
Core therapeutic components
Pharmacotherapy
Electroconvulsive Therapy

2. Treatment Plan General Treatment Guidelines
(given that hospitalization is not required)
Ensuring 24-hour coverage availability including holidays and vacations
Increasing frequency of sessions
Extending session times as necessary
Collaborating with family member and significant others to be involved in treatment
Ensuring the treatment plan is constantly updated
Following up to ensure patient compliance and disposition
Monitoring medication allocation and use
Establishing a check-in system with the patient

3. Treatment Plan
Assuming Professional Responsibility
Follow through with treatment plan to ensure effectiveness. The clinician is responsible for managing the suicidality to the standard of care.
Treatment plans should take into account issues gathered during the risk assessment, with risk management ongoing during treatment
Consider involvement of supportive third parties, such as family and friends. Patient and clinician should remain in contact, as well as any persons involved beyond primary care.

4. Treatment and Management of Suicide Risk:
Safety Plan
A predetermined list of coping mechanisms and support the client has access to
Reduces access to means to complete suicide
Developed with patient involvement
Recognization of the risk of suicide
Difference from No-Suicide Contracts

5. Safety Plan: Example

6. No-Suicide Contracts
Typically takes the form of asking a patient to promise to not commit suicide and seek help from professionals when in crisis
Effectiveness is not supported by empirical data
May obscure a patient’s actual level of suicidality
Does not provide the patient with adequately detailed information about support available and proper responses in times of crisis

7. No-Suicide Contract: Example

8. Treatment and Management of Suicide Risk:
Third Parties
Educating supportive third party members along with the patient
Actions taken to reduce risk
Engaging third parties
Addressing the unique family, social, cultural, spiritual, and socioeconomic needs of patient through psychological interventions

9. Psychotherapy
Have been proven to be efficient in treating disorders associated with increased risk of suicide
Targets deficits in specific skills, which may reduce suicide attempts, when applied for the long-run
Mostly reduces suicide risk through cognitive-behavioral therapy, which helps identify the causes of dysfunctional emotions

10. May help reduce symptoms of mood disorder
Psychotherapy
May help reduce symptoms of mood disorder
Psychotherapies to consider:
Dialectical Behavioral Therapy for patients with personality disorders characterized by emotional dysregulation
Psychotherapies based on cognitive/behavioral approaches or skills training for BPD patients at high suicide risk
Psychodynamic psychotherapies for high risk patients with BPD

11. Psychotherapy: Core Therapeutic Components
Cognitive: deals with irrational negative thoughts, core beliefs and cognitive distortions, and problem solving deficits
Emotional: deals with avoidance of unpleasant experiences activated prior to the suicide attempt
Behavioral: deals with reduced activity and impulsive behavior
Interpersonal: deals with poor communication and impaired social function

12. Types of Therapies:
Cognitive-Behavioral Therapies: emphasizes modification of core beliefs and schemas related to perception of self, the world, and the future
Dialectical Behavior Therapy: emphasizes management of multiple severe problems, suicidal behavior, and extreme emotional sensitivity
Interpersonal Therapy: emphasizes reparation of impaired social functions and addresses interpersonal difficulties that lead to psychological problems
Mentalization-Based Therapy: emphasizes relational aspect of personality disturbance and restructuring self-image and understanding of others

13. Pharmacotherapy
Limited evidence that pharmacological interventions reduce suicide risk
Medication should be reviewed for connections to suicidal thoughts or behaviors
Lithium and Clozapine have been reported to reduce suicide risk in patients with mood disorders or schizophrenia

14. Drugs potentially used to help manage suicide
Pharmacotherapy
Drugs potentially used to help manage suicide
Example Black Box Warning
Anti-depressants
Anti-psychotics
Lithium
Clozapine
Antiepileptic drugs
Anti-anxiety drugs

15. Electroconvulsive Therapy
Can rapidly and efficiently resolve symptoms of several Psychiatric disorders
Could also be a potential treatment for resistant PTSD
Usually considered for suicidal patients who have failed to respond to other treatments
No significant evidence of long- term reduction of suicide risk

16. Electroconvulsive Therapy
Risks and Contraindications
.002% result in death, usually as a result of cardiovascular complications
Adverse side effects include temporary confusion and memory loss, though modern techniques have reduced these side effects
Fractures are reduced by muscle relaxants, though teeth may be broken still
Contraindications are rare, and most can be overcome by preparation before the ETC

17. Treatment and Management of Suicide Risk:
Continuity of Care
Discharge planning
Risk of suicide after discharge
Follow-ups
Transitions between care settings
Behavioral health providers
Connection with chain of healthcare
Updates to treatment plan and safety plan
Documentation