Outline

INTRODUCTION TO THE GROWING PROBLEM OF SUICIDE IN AMERICA

• Need for concern: statistics revealing the increasing trend in suicidal ideation, attempts, deaths
  • National data
  • State-specific data
  • Career risks for the professional counselor
• Factors contributing to the failure of adequate assessment and triage
  • Inadequate training of physicians and professional counselors
  • Inadequate funding for mental health (despite numerous parity laws)
  • Shifting of the burden of assessment to emergency rooms
  • Poorly trained law enforcement officers initiating involuntary admissions

EPIDEMIOLOGY — CONTRIBUTING FACTORS

• Risk factors
  • Demographic risk factors (age, gender, ethnicity, etc.)
  • Environmental risk factors (adverse childhood experiences)
  • Addictions
  • Mental illness
  • Economic risk factors (employment)
• Warning signs
  • Feeling alone—isolated from family/friends
  • Feeling like a “burden” to others
  • Little or no fear of death
• Red herrings
  • Suicide notes
  • Contingent suicide threats
  • Cutting
  • Pending divorce
• Limitations of the research and potential risks

ASSESSMENTS/MEASURES TO AID IN DETERMINING RISK LEVEL — A COMPREHENSIVE STRATEGY

• Mental status exam
• Collateral information
• Adults
  • Relative lethality of plans/attempt (Risk/Rescue Scale)
  • Hopelessness (Beck Hopelessness Inventory)
  • Reasons for living (Brief Reasons for Living Scale)
  • Adverse childhood experiences (A.C.E. Questionnaire)
• Teens and children
  • Predictive/protective factors identified in the research
• Special populations
  • Veterans
  • LGBT
• Promising, novel methods for assessing risk
  • Implicit cognitions—measuring implicit associations with death and suicide

COMMON INTERVENTIONS, MISTAKES, THINKING ERRORS & ETHICAL ISSUES

• Our natural tendencies to err
  • Feelings of “rightness” are not reliable indicators
• External factors contributing to errors
• Internal factors contributing to errors
  • Self-care is critical
  • Two types of thinking (fast and slow)
  • Dangers of lazy, “fast” associative thinking
  • Substitution of easy-to-answer question for more difficult and complex question
• Type 1 vs. Type 2 errors (legal liability and ethical issues)
  • Patient autonomy and self-determination
  • Confidentiality limits

INTERVENTIONS AND TREATMENT PLANNING

• Non-judgmental, empathic listening
• Acknowledging reason for concern
• Taking advantage of ambivalence
• Evidence-based interventions to reduce subsequent suicide attempts
• DSM-5® new definitions and terminology
  • Assess suicidal ideation at the start of every visit
  • DSM-5 level one screening questionnaire
  • Suicidal Behavior Disorder
  • Non-Suicidal Self-injury

CHALLENGES TO ACHIEVING SUCCESSFUL TREATMENT OUTCOMES

• Means restriction
• Social support — supervision
• Follow-up counseling
• Exploring alternative responses should suicidal thoughts increase in frequency/intensity

WHEN LOSING A PATIENT TO SUICIDE — REMAINING RESILIENT AND MOVING FORWARD