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Assessment 5

Risk of Suicide

Abhi Hedemark

1)List 10 possible client factors for increased suicide.


● Mental health issues/illness(schizophrenia, severe anxiety, depression etc)
● Loss of family member or close friend
● Past suicide attempt
● Drug and/or alcohol abuse
● Experiencing family difficulties or violence, past family suicide history.
● Social isolation
● Being male(males have a statistically higher rate of suicide.)
● Serious health problems(chronic pain, terminal illness, chronic illness)
● Significant financial problems
● Access to means of suicide(guns, pills, tall buildings etc)

2)What is suicidal ideation?


Suicidal ideation is the mental consideration, planning, and fantasising about suicide. This can
include dark thoughts about oneself, writing stories about suicide, talking or focusing a lot on the
topic of suicide, and/or an increased attention to death. They may self-harm or have negative
habits that are detrimental to their own wellbeing. They may express feelings of hopelessness
and worthlessness and often become isolated from their usual family/friend base. Most people
who have suicidal thoughts do not end up committing suicide but if they have any of the risk
factors from question 1, then they are at an increased risk of self harm and/or suicidal attempts.

3)What are some of the most important communication strategies to use with someone
who is disclosing suicidal thoughts?
The most important communication strategy to use with someone who is disclosing suicidal
thoughts is unconditional positive regard. A counsellor must use a calm but caring non-reactive
and curious listening approach in order to fully explore all the feelings that are causing the client
to think about suicide without causing the client to feel shame or guilt around these thoughts.
The client must be made to feel comfortable to explore all layers of their suicidal ideation, this
helps the counsellor understand the level of risk that is present and apply strategies according
to those levels of risk. The counsellor must listen intently and kindly, and show a considerable
amount of empathy for the client. This is a client’s cry for help, and the counsellor must listen in
order to restore the client's sense of hope and connection to others outside of themselves.

4)Using the following four concepts in each of the three categories, briefly explain what
factors might be considered as a “low” , “medium”, or “high” risk of suicide
History
Low- ​No previous suicide attempts, mental illnesses, or drug/alcohol abuse and has a good
support system(family, friends, work etc)
Medium- ​history of minor/moderate self harm, expressions of hopelessness and weak support
systems
High- ​has attempted suicide in the past, a family member may have committed suicide, history
of mental illnesses like depression, anxiety, bipolar etc.

Plans
Low- ​The plan is far in the future or undecided, no clear means or practical method of doing it
Medium- ​Set date but more than 3 weeks away, some idea of how they will do it but still not
100% clear or fixed
High- ​Clear immediate date within the next 3 days of stating plan to suicide, clear and
accessible means. All details of the plan are perfectly clear for the client even down to small
details.

Intent
Low- ​Client is thinking about the idea or is simply expressing feelings of hopelessness. He/she
might say things like “I don’t feel like living anymore” but is still clearly looking for alternatives,
has no previous attempts, mental illnesses, or risk factors.
Medium- ​The client has made a decision to end his life in the near future due to various
circumstances, and may let you know that this is what he/she is going to do, client may have
several risk factors, a means to suicide, but is unclear on the plan.
High- ​The client has stated that he/she is determined to suicide, has means, has a plan, and is
committed to carrying out the plan.
Means
Low- ​Client has zero or extremely limited access to any kind of suicidal means.
Medium- ​Client has access to means such as pills, guns, or rope but is lower risk on the history,
plans, and intent factors.
High- ​Client tells you they have their means ready and available, and they are medium to high
risk on all other factors(history,plan, intent)

5)what steps would you take when confronted with a client who is clearly a “high” risk of
suicide?
Immediately end the session and let the client know that you must notify the mental health
services to help protect the life of the client and that this is your duty of care to him/her. I would
try to include the client in the call with mental health services and ensure the client that we are
all there to support him/her. I would not leave the client alone until he/she is in the care of of that
particular service team. I would then notify my supervisor and file all necessary reports.

6)What are the duty of care, confidentiality, and disclosure requirements when dealing
with a client who is at a medium/moderate risk of suicide?
Confidentiality and disclosure agreements can be broken when a client is at a medium risk of
suicide, but my duty of care would be to facilitate a safety plan contract with the client to develop
a strategy to keep the client safe for the next 72 hours. I must try to help the client come up with
strategies to go through in order to help address concerns and negative feelings that are
causing the suicidal ideations. As a part of that plan I would schedule another appointment with
the client within 3 days to re-assess the risk level and provide further options and strategies to
help reduce and eliminate risk factors. I would also notify my supervisor and discuss the
assessment of risk that i have given the client to make sure it is accurate. I must through my
counselling skills such as listening, empathy, and understanding help the client come to a place
where they come to a lower risk level, and develop hope for the future.

7)Does this change when working with a client who is at a low risk of suicide?How?
It changes because the client being at low risk of suicide means I have to abide by the
confidentiality and nondisclosure agreements I have made with the client. Therefore I can only
give out information with the permission of the client and my role remains as a counsellor to
continue providing care and support within the bounds of those agreements. Higher risk of
suicide demands more immediate action to protect the life of the client which stands at the top
of the ethical principles which supersedes all others such as confidentiality.