1. Chapter 6 When crisis is a danger

2. SUICIDE Myths 1. Discussing suicide will cause the client to move toward doing it. The opposite is generally true. Discussing it with an empathic person will more likely provide the client with a sense of relief and a desire to buy time to regain control. 2. Clients who threaten suicide don't do it. A large percentage of people who kill themselves have previously threatened it or disclosed their intent to others.

3. 3. Suicide is an irrational act. Nearly all suicides and suicide attempts make per­fect sense when viewed from the perspective of the people doing them. 4. People who commit suicide are insane. Only a small percentage of people at­tempting or committing suicide are psychotic or crazy. Most of them appear to be normal people who are severely depressed, lonely, hopeless, helpless, newly aggrieved, shocked, deeply disappointed, jilted, or otherwise overcome by some emotionally charged situation.

4. 5. Suicide runs in families-it is an inherited tendency. Sometimes more than one member of a family does commit suicide. But suicide is not inherited. Self destructive tendencies may be learned, situational, or linked to depression or other conditions. 6. Once suicidal, always suicidal. A large proportion of people contemplate sui­cide at some time during their existence. Most of them recover from the imme­diate threat, learn appropriate responses and controls, and live long, productive lives, free of the threat of self-inflicted harm.

5. 7. When a person has attempted suicide and pulls out of it, the danger is over. Probably the greatest period of danger is during the upswing period, when the suicidal person becomes energized following a period of severe depression. One danger signal is a period of euphoria following a depressed or suicidal episode. 8. A suicidal person who begins to show generosity and share personal posses­sions is showing signs of renewal and recovery. Many suicidal people begin to dispose of their most prized possessions once they experience enough upswing in energy to make a definite plan. Such disposal of personal effects is some­times tantamount to acting out the last will and testament.

6. 9. Suicide is always an impulsive act. There are several types of suicide. Some in­ involve impulsive actions; some are very deliberately planned and carried out.

7. Facts and statistics 1 out of 59 individuals in the U. S. has been affected by the suicide of someone close to them Rates have remained stable over the past 40 years About 40,000 people commit suicide and almost 800,000 attempt

8. Males more likely than females to successfully complete suicide Females more likely to attempt, but not be successful Psychiatrists have the highest rate of all professions Suicide occurs within the first 3 months of improvement from an episode of depression

9. 15-19 year olds: 2 nd highest cause of death, car accidents are the main cause 25-30% of alcoholics will attempt suicide 25% of schizophrenics will attempt 25% of dysthymic disorders will attempt, 12 out of 100,000 will succeed

10. Clues and symptoms Giving things away and putting things in order Writing a will Withdrawing from usual activities Preoccupation with death The recent death of a friend or relative Feeling hopeless, helpless, and worthless

11. Increased substance abuse Displaying psychotic behaviors Verbal hints, “I’m no use to anyone, what’s the point?” Agitated depression Living alone

12. Suicide Assessment, Risk Level and Strategy Factor:Response:Risk:Strategy: Ideation: NOLOWSupportive Crisis Intervention. YESGo to next factor to decide Plan: NOLOWCrisis Intervention Verbal No-Suicide Contract YESGo to next factor to decide

13. Factor:Response:Risk:Strategy: Means: NOLOWRegular Contact, C.I. YESMIDDLEWritten no-suicide contract, increase contact, family watch, turn in the means to counselor. Can anything stop You? YESMIDDLEEncourage clients to live for the reasons given; help them find meaning in life NOHIGHPossible involuntary hospitalization. Severe Depression NOMIDDLERefer to physician for a physical and possible medication. YESHIGHPossible voluntary hospitalization. Suicide Assessment, Risk Level and Strategy

14. MANAGING CLIENTS WHO ARE A DANGER TO OTHERS Must keep in mind the Tarasoff decision and duty to warn Must determine if danger is due to a mental disorder (eg. Hearing voices) Must assess for client’s potential for really harming others Some have impulse control problems

15. Assessment 1. Is the client actively or passively engaged in violent or dangerous behavior now? 2. does the client state s/he is going to carry out violent/dangerous behavior? 3. Does client have a plan? 4. Does the client have the means? 5. Does the client have a background of violence and dangerous behavior? 6. Has the client acted on plans for violence in the past?

16. Intervention May need involuntary hospitalization Must report to police if deemed violent to another May teach clients ways to contain violent urges through anger management groups. Medication may be useful if client shows severe psychiatric symptoms Antisocial disorders may be cases to refer to law enforcement Informing clients that therapists are required by law to report abuse helps control impulses