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Responding to identified suicide risk

A framework for responding to risk of suicide across different settings and circumstances. If your situation is unique, consult with Carmen to develop an approach appropriate to those circumstances.

Responding to a suicidal crisis can be confronting. What we do and how we do it can depend on our role, responsibilities and experience but not matter what, don't ignore the opportunity to make a difference in someones life. The importance of consultation can not be over stated when it comes to people in situations of acute risk.

The below model for crisis response demonstrates the need for practitioners to be performing multiple tasks concurrently. There are times when a linear approach is okay, but we must be attune to the fact that in crisis situations, our personal communication skills and ability to develop rapport is just as important as gathering information about the crisis, assessing the level of risk and determining the available resources.

SRAA crisis response - website-page-001

In times of imminent risk, we need to be direct in what will keep the person (or people) safe. Being direct does not mean acting rashly and risk management strategies will likely vary for different clients and under different contexts.

The following diagrams are excerpts from our Foundations to Suicide Risk Assessment workshop, complemented by some general guidance. In all instances, please consult with a professional if you are uncertain or to ensure your approach is appropriate to the circumstances. If you would like to learn more, or develop these skills, consider registering for the Foundations workshop.

 

Working with Family and friends of suicidal clients

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Gather information from and provide education to family and friends with the following key questions and approaches;

  • Support them to know the warning signs for suicide and take action - ask them to consider - is the person:

    • Making comments about suicide?

    • Have they increased their use of alcohol or other drugs?

    • Are they giving away their belongings or tidying up their affairs?

    • Do they seem withdrawn or disinterested in others?

    • Are their sleep patterns disrupted or abnormal?

    • Are their behaviours suddenly unusual, upsetting or difficult to understand

  • Be aware of any triggering events that may suddenly increase the person’s risk – marital problems/separation, fights with significant others, financial or legal problems and use these stressors as an opportunity to talk with the person about how they are feeling.

  • Ask the person directly if they feel suicidal. (Asking the question does not cause the person to feel more suicidal).Remain non-judgemental and supportive. Keep listening and talking with the person. This can be hard but it is important.Seek support - talk about what you have noticed with your doctor, psychologist, counsellor or psychiatrist. Call a help line such as Lifeline (13 11 14) if you need to. Don’t put it off.

    • If they say yes, be brave and ask whether they have a plan.
    • If they do, ask if they have access to the method or means to suicide and
    • Ask whether they had a time they planned to do it.
    • Remove the means immediately and get support from mental health professionals
    • Seek support for how to manage the risk in the longer term in necessary (such as family systems therapy).
  • Call an ambulance or the police if you feel like the risk is very high or if something suddenly changes for the worse (such as if they become upset with you for trying to interevene in their plan).

  • Above all, remain involved and it is essential that this is with the support and guidance of professionals.

Community

  • Identify key people who are representative of and connected to the community who can act as coordinators or “go to” people in times of need. This may be Elders, coaches, religious leaders, teachers, managers or prominent personalities known to the majority of the community.

  • Ensure community leaders have training in mental health issues, including how to appropriately identify and respectfully respond to someone feeling suicidalIn consultation with the community and in line with culturally safe protocols, develop a clear and manageable intervention plan for times of crisis. This should involve clearly defined stages and escalation points, depending on the severity of the concerns, including strategies for managing suicide risk. Please enquire for more information on how this may be undertaken for your community group.

    • see “Managers as Gatekeeper” training

    • community leaders should also have access to ongoing support in times of need

    • identification of mobilised mental health services and supports who may be immediatly available if needed

  • Regardless of the kind of ‘community’ you are part of; your local residential area, sporting club, CALD, religious, LGBT, school, work or other interest group, work towards continuous provision of a safe, accepting and secure environment.

  • Maintain connections within your community and support those members who seem to be challenged or going through a more difficult time.

  • Provide education and understanding on mental health problems and where people can go for help. This includes posting notices in common areas or meeting venues and providing opportunities for community leaders to be approached for advice or guidance.

  • When the term "suicide" is known to be confronting or taboo in the community, it is important to acknowledge the underlying symptoms that may be experienced by the community instead: hopelessness, fear or shame for example to ensure the conversation continues.

Workplaces

  • Develop and support a workplace culture that is accepting and non-judgemental with regards to mental health difficulties and times of adversity.

  • Concurrently, develop a culture engaging and promoting resilience based practices (eg. lunchtime exercise, team building, open communication)

  • Ensure managers, supervisors, foremen or other people in key work roles are trained in identifying workers/staff who may be struggling emotionally and equip them with strategies for appropriately responding to requests for help.Develop policies and protocols to guide and support employees in how and where to seek help from within their workplace

    • See “Managers as Gatekeepers” training

  • In line with the severity of the concerns held for the worker, the employer should have clearly defined escalation points for intervention, varying from;Follow your industry (and workplace) guidelines for working with suicidal clients (eg. Australian Psychological Society Guidelines or Royal Australian and New Zealand College of Psychiatrists, Counsellors and Psychotherapists Association)

  • Generalised support through the offer and/or provision of confidential Employee Assistance Program (counselling) service

  • More formalised interventions/assessments/support by way of employer endorsedEnsure managers, supervisors and “gatekeepers” have access to support and that they are equally engaged in resilience based activities

  • Time off work to access treatment or resilience building programs during work hours

  • Health/wellbeing/psychological assessment with treatment recommendations and adjustments to work if indicated

  • Actions to identify or remediate any work related stressors

  • Protocols for managing critical incidents, including acute distress, violence or suicidality in the workplace

  • Engaging family &/or friends in supporting the worker from a wholistic persepective

  • Remember that a supportive and inclusive workplace culture starts at the top - Managers lead by example

 

Psychologists/Counsellors in private practice /Consultants

Suicide Risk Assessment Australia explore our responsibilities as practitioners responding to suicidal crises through the Legal & Ethical Aspects to Suicide Risk Assessment and Management workshop.

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  • Ensure you conduct a best practice suicide risk assessment (see SRAAs workshops) and use the assessment to guide your treatment recommendations and approach

  • Engage a multidisciplinary approach to client treatment/management, including;Provide psycho-education to key stakeholders where necessary on suicidality and aim to reduce stigma

    • Case conferencing with their GP, Psychiatrist, Crisis Care Team, Specialists etc

    • Referral to multidisciplinary pain management teams, dual diagnosis/substance dependence/withdrawal programs

    • Recommend a medication review (where indicated and appropriate)

    • Work collaboratively with their family, community or employer (where indicated and appropriate) to ensure the client is considered and supported from a wholistic perspective

    • Adopt a short term problem solving/case management approach in circumstances where

      • the client’s symptoms or immediate circumstances appear to limit their insight

      • the client demonstrates 'black and white' thinking and is unable to see alternative solutions or options due to rigid thinking style (which may be symptomatic of their distress)

      • situational factors exacerbate the severity of distress eg. referral to a Solicitor/Legal Aid, introduce the client to AOD services - putting a face to the name for them

      • engage a Social Worker to assist with this where possible

  • Remain engaged and recognise that suicidality is a fluid process and requires constant and regular monitoring while active

  • Seek supervision and support from colleagues, supervisors and/or the multidisciplinary team. Engage external supervision if needed.

For more specific recommendations appropriate to your situation, consult Carmen

(c) Copyright Carmen Betterridge 2014

 

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