Suicide Lethality Assessment G505, Individual Appraisal April 8, 2003

Suicide Facts Second leading cause of death among teens Among top five leading causes of death among senior citizens Dynamics of suicide also apply to assessment of homocidal thinking

Suicide Facts Women –Make more attempts –Make less lethal attempts –Succeed less often Men –Make fewer attempts –Make more lethal attempts –Succeed more often

Why Do People Attempt Suicide? Escape Revenge Punishment manipulation Cry for help

People do not attempt suicide to die

Three Elements of Suicidal Ideation 1. Thoughts of suicide - distinguish from “morbid thinking” -thoughts vary in intensity 2. Presence of a plan -plans vary in degree of development and sophistication 3. Degree of intent

Levels of Suicide Lethality Level 1 –Vague to moderate suicidal ideation –No organized plan –No expressed intent Level 2 –Moderate to intense ideation –Vague plan –Some intent, not specific time frame

Level 3 Intense ideation Organized plan (particularly if lethal (e.g., shooting, hanging) Strong intent Lethality increased if there is a past history of suicide attempts

Other Contributing Factors Lethality of suicide method History of past attempts Drug/alcohol abuse history History of suicide by family members Recent significant losses Profile of numerous stressors

Symptoms of Suicidal Thinking Depressed mood Expressed hopelessness Social withdrawal Direct and indirect “saying goodbye” –Actually saying goodbye –Giving things away –Putting affairs in order –Abruptly ending relationships

Suicide Crisis Intervention Clients who articulate suicidal ideation are ambivalent They are asking for help Suicidal persons who do not want help often commit suicide without indicating their intent to anyone directly

What Counselors Should and Should Not do... Do... –Take the ideation seriously –Acknowledge the ideation directly –Asssess lethality level –Empathize –Express your desire that the client live –Express your commitment to help find solutions –Take steps to protect client according to client’s age and lethality level

What Counselors Should and Should Not do... Don’t... –Ignore or downplay the ideation –Avoid discussing the ideation –Argue with or berate client –Give Pollyannish reasons for staying alive –Fail to adequately protect client

Protective Steps “No Suicide” pact –Agreement not to attempt –Aggreement on preventative strategy –Short term goal (often your next appt) Contacting potential monitors/supervision Admission to hospital Involvement of authorities