For example, support the client to undertake a functional analysis on what was occuring when they last transitioned from ideation to behavoiur. Use this as evidence to avoid similar circumstances in the future where possible. Work with your client to develop distress tolerance techniques that are effective and specific to them. Use the Safety Plan to personalise and maximise the value of their strategies to them.
This is an excellent resource from the Suicide Prevention Resource Centre, Education Development Centre and Universal Health Systems (in the USA), published by the Education Development Centre. Professor David Jobes is an exceptional representative of evidence based practices and championing the need to provide services that are demonstrated to be effective.
Use the download available or work through the below techniques and strategies with your client. Allow the client to reflect on the value of each technique, how it can apply to them and support them to think strategically in how and when they may apply the strategy. That is, identify their critical point – when they might become fearful that thoughts become action.
Explore and discuss the following with your client
Any client disclosing (general) suicidality should be encouraged to call their GP and obtain a mental health care plan – a referral to a Psychologist and/or a Psychiatrist. Recommend that the client does not manage their feelings alone and emphasise that these feelings vary from moment to moment and day to day. As a matter of practice, the client should be monitored and followed up to ensure that this has occured.
If you are in a position to do so, complete a suicide risk assessment and determine the severity of suicidal ideation. Practitioners finding that their client is high risk (has a plan, means and time for suicide) need an immediate intervention which may include collaborating with them to advise their family/trusted other or transportation to hospital if the risk is imminent.
Ensure that clients have a safety plan for after hours, should their suicidal ideation intensify; call Lifeline (Ph 13 11 14) or another telephone support service, stay with a friend or attend the Emergency of their local hospital (via ambulance if necessary).
The below strategies are only temporarily and do not replace the longer term psychological treatment required.
Remove methods and challenge the trigger
- If you have made a plan to harm yourself, tell someone about the plan
- If you have the means to harm yourself, tell someone and/or give the means to someone
- If your thoughts are triggered by predictable things, like fighting with your spouse or family, talk to a professional about how fighting makes you feel, try to problem solve and work to minimise the impact those triggers have on you – this can take time
Understand your suicidality
- Work with a practitioner to understand how to move away from suicidality and towards life and hope
- Recognise that your thoughts are just thoughts and don’t define your behaviour
- Push yourself to see how your suicidal ideation fluctuates whereby you can tell yourself to wait until the intensity passes
Distraction techniques instead of self injury
- Hold an ice cube in your hand, concentrate on how cold it is and the drops of water dripping between your fingers
- Flick a rubber band against your wrist
- Scream into a pillow
- Call a crisis or help line
- Take a deep breath and hold it, then try to breath further into the held breath until no more air will fit
Distract yourself by doing chores
- Clean your windows
- Plan and cook an elaborate meal
- Mow the lawn and weed the garden
- Clean your bathroom and use a toothbrush to scrub the grout in hard to reach places
- Scrub your oven and griller or clean your microwave
Make a plan for regular exercise
- Walk around the block for half an hour, fast enough to lose your breath
- Drive to the beach or park and jog until your legs are tired and you can feel your muscles
- Ride a bike or go for a swim
- Do stretching, yoga or Pilates
- Do squats, push ups or sit ups
Ensure you are sleeping well
- Avoid coffee, alcohol and stimulants before bed
- Practice a consistent bed time routine; go to bed and get out of bed at the same time every day
- When you can’t sleep, practice relaxation, breathing and meditation exercises
- Don’t nap in the day
- Remove the TV or computer from the bedroom
- Talk to your GP or Psychologist about how to get better sleep
Do something nice
- Visit a friend
- Go for a walk, breathe deeply, feel the air on your skin and listen to the sounds around you
- Plan your ideal, dream holiday in great detail
- Take a hot bath and visualise your worries being washed away
- Watch a comedy movie
- Catch the bus, train or ferry somewhere interesting and new
Focus on someone you care about or admire
- Think of a peaceful and gentle conversation with them and the words of wisdom and love they would offer you
- Think of your teen idol and imagine planning a visit to talk with them about how they managed stress in their life
Above all, remember that you deserve support so reach out and accept it
The feeling of being extremely overwhelmed usually passes with a little time. Give yourself that time by distracting yourself.
Work with a mental health practitioner to set yourself goals, work through your feelings and problem solve difficult issues.
Make a plan and commit to developing your inner strength so that you are protected from feeling suicidal again. Talk to a psychologist, psychiatrist or counsellor on how to achieve this.
Avoid drinking alcohol or using any substances, sometimes these can trigger upsetting feelings and fuel negative thoughts.