1. Chapter 9 – Suicide Assessment

2. Chapter 9 This chapter focuses on a contemporary approach to conducting a suicide assessment interview—as well as brief suicide interventions.

3. Chapter 9 The duty to protect clients in potential cases of suicide and homicide is an ethical and legal mandate. You can never know when your next client might be suicidal (or homicidal).

4. Chapter 9 Personal Reactions to Suicide As we discuss suicide and suicide assessment, be sure to monitor your own personal reactions and take time to talk with someone you trust if this topic raises strong emotions in you.

5. Chapter 9 Suicide Statistics In 1991, the average suicide rate was 12.2 deaths per 100,000 people. It was under 10.0 deaths per 100,000 people in 1999. In 2004, it was 11.0 deaths per 100,000 people. In 2010, it was 12.4 deaths per 100,000. Suicide is very difficult to predict.

6. Chapter 9 Suicide Risk Factors IS PATH WARM is typically referred to as evidence- based and, in fact, it was developed based on known risk factors and warning signs. What are your thoughts on the utility of IS PATH WARM?

7. Chapter 9 Suicide Risk Factors: Mental Disorders and Psychiatric Treatment Schizophrenia Depression Bipolar Dx Post-Traumatic Stress Substance Abuse Post-Hospital Discharge SSRI Administration

8. Chapter 9 Suicide Risk Factors: Social and Personal Factors Social isolation/loneliness Physical illness Previous attempts Unemployment Sexual orientation

9. Chapter 9 Suicide Risk Factors: Demographics Sex Age Race Religion

10. Chapter 9 5-Minute Discussion Suicide Risk Factors: The Checklist What are your thoughts/reactions to the suicide risk factors described in this chapter? Do you think having the risk factor checklist might be helpful to you in your interviewing assessment? Could it be harmful? If so, how?

11. Chapter 9 Suicide Assessment Interviewing A reformulation of suicide assessment A constructive critique Differential activation theory Depressogenic social, cultural, and interview factors Adopting a new client and suicide-friendly interview attitude

12. Chapter 9 Assessing Client Depression DSM forms of depression Mood-related symptoms Physical or neurovegetative symptoms Cognitive symptoms Social/interpersonal symptoms

13. Chapter 9 Personal and Family History It is good practice to assess for previous attempts by the individual and within his or her family. A family constellation interview or genogram can help with this.

14. Chapter 9 Exploring Suicide Ideation Ask directly and calmly. Asking compassionately about suicidal thoughts will not create those thoughts. Explore the frequency, duration, and intensity of client suicidal thoughts.

15. Chapter 9 Assessing Suicide Plans Specificity Lethality Availability Proximity of social support

16. Chapter 9 Assessing Client Self-Control and Past or Familial Attempts Is there fear of loss of control? What are the client’s reasons for living that reduce or prevent suicide impulses? Is there a history of impulsive acts?

17. Chapter 9 Assessing Suicidal Intent Absent Low Moderate High

18. Chapter 9 Suicide Intervention Listening and being empathic Establishing a therapeutic relationship Suicide prevention contracts Safety planning Alternatives to suicide Separating the psychic pain from the self Becoming directive and responsible Making decisions about hospitalization

19. Chapter 9 Professional Issues Can you work with suicidal clients? Consultation Documentation Dealing with completed suicides

20. Chapter 9 Summary and Concluding Comments