1. Presented by: Kendra Watson Sam Houston State University Ethics Institute Fall 2004

3. After Counseling

4. “It is legitimate and necessary to wonder whether life has a meaning, therefore it is legitimate to meet the problem of suicide face to face.” Albert Camus Nobel Prize-winning author The Myth of Sisyphus

5. Code of Ethics Marriage and Family Marriage and Family Texas Counseling Association Texas Counseling Association American Counseling Association American Counseling Association American School Counseling Association American School Counseling Association

6. Confidentiality: Exceptions You are in danger to yourself or others You are in danger to yourself or others A court order to disclose information A court order to disclose information Disclosure of child abuse or elder abuse Disclosure of child abuse or elder abuse Disclosure of a previous exploitation by a helping professional in a therapeutic relationship Disclosure of a previous exploitation by a helping professional in a therapeutic relationship Other reasons specified by laws of this state Other reasons specified by laws of this state Usually stated on a counselor’s informed consent at the beginning of counseling

9. Video Clip from Lethal Weapon Clip from Lethal Weapon

10. Suicide Statistics 30,000 suicides annually 83 per day, 1 every 17 minutes Eighth leading cause of death Most used method is firearms Ranks third as cause of death for the young. (Behind accidents and homicide) For each death by suicide there are usually 8 to 20 attempts Best predictor: feelings of hopelessness At least 4.4 million Americans are survivors of a loved one’s suicide Source: www.suicidology.org “American Association of Suicidologywww.suicidology.org

11. How?

12. Where?

13. Rating scales Sense of Worthlessness Sense of Hopelessness Social Isolation Depression Impulsiveness Hostility Intent to Die Environmental stress Future Plans

15. Surviving Loved Ones Letter from a family member

16. Ethical Decision Making What do you plan to do if this is your client?

17. The Plan Does the client  have a definite plan?  have a method of carrying out the plan?  have accessibility to the method?  have previous psychiatric history?  have prior attempts  have a suicide note or instructions for survivors  use drugs or alcohol

18. Counselor’s Options No Suicide Contract No Suicide Contract Suicide Watch Suicide Watch Voluntary commitment Voluntary commitment Involuntary commitment (can only be done by a police officer or a guardian if the client is under 17 and not married) Involuntary commitment (can only be done by a police officer or a guardian if the client is under 17 and not married)

19. The Suicidal Threat What if I have a client that threatens suicide often? Do I really have to report it each time when I know all they want is attention?

20. What happens when you call the P O L I C E 1.Clearly state your problem 2.Give the location of your client and of yourself 3.Give the name of your client, age, sex, race, and address 4.Give the client’s phone number and cell phone number 5.Describe the client’s vehicle 6.Give any potential dangers such as children or other family members 7.Inform the police of the method and location of the lethal item 8.Ask for a phone call from the officer when he clears the call

21. What will the police do? Their own assessment of lethality Their own assessment of lethality Informal Options Informal Options Contact family or friends Contact family or friends Formal Options Formal Options Hospitalization Hospitalization Jail Jail

22. Police Video Scenario Video Scenario Crisis Intervention Team training Crisis Intervention Team training

23. How do police make their ethical decisions Police follow the Texas Mental Health Code regarding the warrantless apprehension of individuals in mental crisis. Police follow the Texas Mental Health Code regarding the warrantless apprehension of individuals in mental crisis. http://www.capitol.state.tx.us/statutes/hstoc.html http://www.capitol.state.tx.us/statutes/hstoc.html http://www.capitol.state.tx.us/statutes/hstoc.html HEALTH & SAFETY CODE CHAPTER 573. EMERGENCY DETENTION HEALTH & SAFETY CODE CHAPTER 573. EMERGENCY DETENTION

24. Texas Mental Health Code A police officer, without a warrant, may take a person into custody if the officer: A police officer, without a warrant, may take a person into custody if the officer: Believes the person is mentally ill and because of that mental illness there is a substantial risk of serious harm to the person or others unless the person is immediately restrained, and Believes the person is mentally ill and because of that mental illness there is a substantial risk of serious harm to the person or others unless the person is immediately restrained, and Believes that there is not sufficient time to obtain a warrant Believes that there is not sufficient time to obtain a warrant

25. Future concerns How can police and mental health professionals work together for the best interest of the client? How can police and mental health professionals work together for the best interest of the client? Mobile Crisis Response Teams Mobile Crisis Response Teams Mental health courts to deal with person whose impaired minds cause impaired behavior Mental health courts to deal with person whose impaired minds cause impaired behavior

26. Future Vulnerable Populations Military returning from war on terrorism Teenagers Elderly Professionals in stressful careers

27. References American Association of Suicidology www.suicidology.org Castellano-Hoyt, D. (2003). Enhancing police response to persons in mental health crisis. Illinois, Charles C Thomas Publisher. DePaulo, J. R. (2002). Understanding depression. New Jersey, John Wiley and Sons. Marcus, E. (1996). Why suicide? New York, Harper Collins Publishers. Texas Mental Health Code http://www.capitol.state.tx.us/statutes/hstoc.html http://www.capitol.state.tx.us/statutes/hstoc.html