Suicide Risk Assessment

Thoughts, myths, questions about suicide 1.Is suicide a form of manipulation? 2.Will asking about suicide lead to suicidality? 3.When a person talks about suicide are they “just” seeking attention?

Assessment of Suicide Risk

1.Client’s current state: IS PATH WARM ideation substance abuse purposelessness anxiety trapped hopelessness withdrawal anger recklessness mood changes

2. Mental disorders with very high rates of suicide 90% have a diagnosable mental disorder Eating disorders: 258/100,000 Bipolar: as high as 20% Schizophrenia: 15% Antisocial personality: 5%; 46% attempt Borderline personality: 5-10% Major depression: 6%

3. Risk Continuum No indications Suicidal ideation Suicidal plan Access to plan History of attempt

Watch dvd for example

Role Play to Assess Risk In triads, rotate the three roles. Counselor- –What brings you in today? –Use observational skills and watch for risk factors –Ask questions intentionally Observer- –Observe the client for incongruities, nonverbals, etc. –Watch how client responds to questions asked. Client- –Use the scenario given

Problem Solving and Crisis Management

Respond according to risk level Low level of risk Talk about it Address particular triggers Contract Obtain support from friends/family Identify and plan use of crisis services Explore reasons for not killing self Refer for psychiatric evaluation

Responses, cont. Higher level of risk Schedule additional appointments Eliminate potential methods, e.g. weapons, meds, etc. Develop a safety plan Explore option of voluntary hospitalization Contact CDMHPs for involuntary outpatient or commitment evaluation hours, 14 days, 90 days inpatient 90 (adult) or 180 (youth) days of outpatient

Risk factors for suicidality-American Association of Suicidology Hopelessness Rage, uncontrolled anger Vengeful Reckless, impulsive or risky bx. Feeling trapped Increased use of alcohol/drugs Dramatic mood change Anxiety or agitation Sleep disturbance…too much or too little No reason to live

Some stats-2005 National rate=11/100,000 Washington rate=14.6/100,000 Varies by age: –75+=16.9/100,000 –5-14=.7/100,000 Varies by ethnicity and gender –Highest: white male=19.7 –Lowest: black females=1.8 –The rate of suicide for black teen females has increased in recent years. Recent study: 7% will attempt.