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INTERVENTION ASSESSMENT SUICIDE - Coggle Diagram
INTERVENTION ASSESSMENT SUICIDE
Triage Form in Adressing Lethality
must not hesitate to ask question as
don’t sugarcoat this question for fear of activating suicidal urges in the client
Are you thinking about killing yourself?. . . about killing someone else? How? When? Where?
if you get a positive answer, you need to fully explore the dimensions and degree of that lethality by assessing across affective, behavioral, and cognitive dimensions
collaboration and empathy are key components
SIMPLE STEPS
Suicidal/homicidal?
Are you thinking of killing yourself/someone else?
Ideation
How likely are you to kill yourself/some- body else in the next 72 hours?
Method
How will you kill yourself/somebody else?
Pain
On a scale of 1 to 10, how much psychological pain are you in at the moment? Is there anything
you can think of that would make it go higher?
Loss
Have you suffered a loss recently or a signifi-
cant loss in the past you are not over?
Earlier attempts
Have you ever tried to kill yourself/ somebody else before? What happened? What
made it not work?
Substance use
Are you currently drinking alcohol
or using drugs? What medications are you tak-
ing, and are you taking them as prescribed?
Troubleshooting
How tied up in this are your job, family, and so on? And what might change to stop this? Are you willing not to consider killing yourself/somebody? If a miracle happened and you awakened tomorrow and everything were
fine, what would that look like?
Emotions/diagnosis
Have you ever been diagnosed
with a physical or psychological illness? How are you feeling right now, and have you ever felt this way before? If so, how often? Have you or are you currently seeing a human service worker of any kind for this problem?
Parental/family history
Has anybody in your family thought about or committed suicide or homicide? Have your parents experienced any emotional problems?
Stressors and life events
What is going on in your life that leads you to think that suicide/ homicide is a viable option or solution to your problems?
The 3 I's
The person confronts a situation he or she believes to be inescapable, intolerable, and interminable
reestablish in clients a sense of hope and to diminish their sense of helplessness
address not the lethality directly but the perturbation the I’s are causing.
Clients need to
be taught to either use existing problem-solving skills or generate new ones so that they can shed the inescapability of unsolvable problems
develop self-awareness and self-observation strategies to observe natural fluctuations in pain levels and make associations between doing things a bit differently and feeling better
they can learn that emotional pain will not be constantly intense and interminable.
what I want to do is to under- stand what’s bothering you, so I can get you some help. What is it that we need to focus on to get you some relief?
learn that negative feelings can be tolerated by distancing and distraction skills so that they are seen as a part of life and not something that is overwhelming and interminable
Whenever a person is emotionally overwhelmed and immobile, one effective way to break through that immobility is to personalize the interaction.
establish a first-name communication as early as possible
establish rapport with the person by establishing a first-name basis of communication.
validate suicidal actions as a way to relieve emotional pain by matter-of-factly stating what they are doing and seek to elicit what is causing them to do it
use a validation technique from dialectical behavior therapy
accept the client exactly as they arr in the moment
I can see you’re carrying such a heavy load to think that the only way of unburdening yourself is killing yourself
Psychological autopsy
examination of of personal demographics such as work, criminal, school, and medical records along with in-depth interviews of friends, relatives, coworkers, and health care professionals to attempt to ascertain the suicide’s intent.
attempt to determine what the trigger events were that might have contributed to the suicide.
attempt to determine what, if any, psychopathology was present in completed suicides.
the big five psychiatric diagnoses that are prcursors to suicide
major depressive
anorexia nervosa
antisocial personality disorder and schizophrenia
borderline personality disorder
bipolar
QUESTIONS
Why did the per- son do it?
How did he/she do it?
When? That is, why at that particular time?
What is the most probable mode of death?
What role did alcohol and/or drugs play in the person’s life?
What was the nature of his/ her interpersonal relationships?
What were the person’s fantasies, dreams, thoughts, premonitions, or fears re- lating to death, accident, or suicide?
What changes, if any, occurred in the person’s habits, hobbies, eating, sexual relations, and other life routines?
Besides details of the death itself, the autopsy seeks to determine the person’s personality and life- style, typical patterns of reactions to stress, emotional upsets, and periods of disequilibrium, particularly in the recent past.