Aka: Do I take this serious? Dr Lisa Arieta Hayes

 We are required to report suspected:  Physical abuse  Sexual abuse  Serious neglect  Suicidal ideation with intent  Homicidal ideation with intent

 Age  Sex  Stress  Symptoms  Prior Suicidal behavior  Current degree of planning  Resources

 Female Youth  Most at risk ages  Male Youth  Most at risk ages  Female Adults  Ages  Male Adults  Ages 70 years and above

 Helpless/hopeless  Anger or fighting  Insomnia or hypersomnia  Self inflicted injuries  Giving away belongings  Developing will and/or saying goodbye  Making threats to kill self/others

 Unrealistic guilt  Isolating from friends and family  Resentment and hate  Increased alcohol and drug abuse  Poor appetite or overeating  Poor self care and hygiene  Crying  Poor health

 Intent  The client makes verbal statements “I wish I was dead” “I want to die” “I’m gonna kill myself!  The client has thoughts “I can’t go on” “I’m in too much pain but I can’t tell anyone”  Passive intent – no real plan  “I want to die but haven’t thought how I would do it”  “I just wish a car would hit me”  “I wish I just wouldn’t wake up”  Clue is person has No Active Plan

 Plan  Time line of when E.g. anniversary of husband’s death  How Pills, gun, hanging etc…  Where At home after everyone leaves  The client shares a clear plan then 5150  The client has no plan – then no harm contract and constant monitoring Check in each time you see them and renew each week

 Lethality  Method will likely result in death  Has easy access to the method  In possession of the method  Not lethal e.g. jump out of plane, take birth control pills  History of previous attempts  Must get details of each attempt and what happened e.g. took bottle of aspirin, hospitalized, stomach pumped  No as serious attempts e.g. superficial cuts; taking medication that is not lethal or not taking enough e.g. took 2 valium

 Contracting  Contracts does not mean a client will not commit suicide  Even is a client signs a contract it does not mean that they will not change their mind  Contracts represent good faith effort and agreement of client with you to work together on this problem  Important to have with clients who have no plan but often has thoughts of suicide/death

 Includes agreement not to harm self  Promises not to harm self unless contact therapist, crisis/suicide hotline, or agency’s 24 hour answering services first  Time limited  Reviewed and documented constantly  Agencies usually have boiler plates to use – ask your supervisor for a copy or where to find on agency shared drive

 Find out protocol for your agency  Seek out policy and procedure with supervisor  Review no harm contract  Seek out supervision IMMEDIATELY when you have any questions regarding suicide

 Questions?