VIEWS: 4 PAGES: 22 POSTED ON: 6/29/2012
Crisis Intervention with Potentially Dangerous Individuals Working with clients who pose a danger to either themselves or other people. Suicide: Facts & Figures • 25,000-50,000 Americans commit suicide every year. Suicide may be more common than homicide. • 300,00-600,000 suicide attempts annually; 15% of those who attempt suicide will eventually succeed. • Attempt to complete ratio is approximately 10:1. • 1/3 of Americans will experience suicidal ideation during their lifetimes. • Most common methods of attempting suicide: overdosing (80%) followed by cutting wrists (10%). • Most lethal method: firearms (60% of completed suicides). • Males are 4-5x’s more likely than females to complete suicide; females are more likely than males to make non-lethal attempts. • Highest Demographic Risk: White males over age 65. • 80% of those who complete suicide had previously communicated this intention to another person. • As many as 15% of clients with chronic depression or alcohol dependence will eventually commit suicide; 10% rate for those with BPD or schizophrenia. • Alcohol is involved in 15-50% of suicide attempts. • Most people who commit suicide were experiencing a mental disorder at the time. • 20-50% of mental health professionals will lose a client to suicide. Risk Factors & Warning Signs • Direct verbal warnings. • Recent loss (divorce, • Suicidal Ideation or Plans. unemployment). • Family History. • Alcohol & drug problems. • Prior hx. of self- • Finalizing one’s affairs. destructive behavior. • Lack of social support. • Prior psychiatric hospitalization. • Poor impulse control. • Chronic physical illness. • Tunnel vision. • Depression: especially • Poor problem-solving hopelessness & insomnia. skills. • Personality Disorder. Psychological Intent for Suicide 1. Hopeless Suicide: pessimistic view that life is unbearable & will not get any better; view suicide as the only solution. 2. Psychotic Suicide: tired of battling a chronic, psychotic disorder; person may also experience command hallucinations & delusions. 3. Rational Suicide: view suicide as a reasonable solution to a terminal illness; desire relief from current or future suffering. 4. Impulsive/Histrionic Suicide: driven by a desire for attention, revenge, or stimulation; they hope attempt will change other people’s behavior toward them. Level of Dangerousness No Danger Depression or Recent Loss Hopelessness Passive Suicidal Ideation Active Suicidal Ideation Current Attempt Assessing Suicide: Funneling 1. Complete thorough assessment: focus on risk factors, mood, psychiatric history, A & D use, support system, & outlook on the future. 2. Inquire specifically about past and present suicidal ideation, plans, or attempts. 3. If suicide is a concern, obtain additional information: • Frequency/intensity of thoughts. • Specificity & lethality of plan. • Availability of means. • Probability of rescue. • Expectation of attempt. • Identify barriers (reasons to live) or resources that might prevent suicide. “What has stopped you from committing suicide?” Example Questions (Zuckerman, 1995) • “Has it crossed your mind that death would relieve you or end your pain?” • “Have you felt ‘my life is a failure’ or ‘my situation is hopeless’?” • “Have you thought about how you might kill yourself?” • “Have you made any plans to hurt or kill yourself?” • “What would prevent you from killing yourself? Overdosing Frequently Used Drugs • Anxiolytics & Sleeping Pills. • Tricyclic Antidepressants (e.g., Elavil). • Aspirin. • Acetaminophen (i.e., Tylenol). • As a very general rule of thumb, 10x’s a normal dose of a dangerous drug is lethal. Special Issues with Adolescents • Suicide rate among adolescents has increased in recent years, but continues to be lower than adult rates. • Reluctance to confide in adults; collateral information can be very valuable. • Younger adolescents may not fully understand the irreversibility of death. • “Personal Fable” Mentality. Intervention Strategies Develop a crisis management plan, including emergency procedures. Remove dangerous objects (guns, pills). Develop a Care Team to monitor client at home. Consider hospitalization, psychiatric consultation, or intensifying treatment. Closely monitor care. .... Work with client’s strengths & reasons for living. Help client identify specific alternatives to ending his or her life. Improve problem solving & coping skills. No-Harm Contracts: • Objective: client makes a commitment to not harm himself for a specific period of time. • Components: 1. Emergency contact numbers. 2. Steps to follow in the event of an emergency (e.g., call crisis line, go to ER). 3. Prevention Plan, include practical coping skills. 4. Identify who can provide social support. Self-Mutilation & Other Parasuicidal Behaviors • Definition: inflicting harm on one’s body without any intention of death or serious injury. • Typical sufferer: young female (15-25) with a history of childhood abuse or neglect. • Manifestation: (1) scratching, cutting or burning one’s arms, wrists, face, legs, genitals, etc.; or (2) preventing wounds from healing. • Co-Morbid Problems: eating disorders, mood disorders, BPD, & chemical dependency. • Duration: chronic & compulsive course lasting 10-15 years. • Ironically, sufferers typically feel little pain while engaging in self-mutilation. Why do people self-mutilate? 1. Tension reduction. 2. Coping with negative emotions (e.g., turn emotional pain into physical pain). 3. Interpersonal communication (e.g., manipulation). 4. Atonement for perceived sins. 5. Hatred toward one’s body or sexuality. 6. Self-stimulation (“to feel something”). 7. Feel more powerful & in control of one’s life. 8. Psychosis. Coping Strategies to Reduce Self-Mutilation: • Engage in non-harmful sensation-seeking (e.g., submerge arm in ice water). • Destroy something non-living & invaluable. • Use a red marker rather than a knife. • Response Prevention. • Direct verbal expression of feelings. • Distraction. • Social Engagement. • Physical movement or Exercise. • Relaxation Techniques Potentially Violent Clients: Risk Factors • History of violent or impulsive behavior. • Family conflict. • Low frustration tolerance. • Former or current legal issues. • A & D Use. • Plan for committing violence. • Means for carrying out violence. Gravely Disabled Clients • Responsibility to protect people who cannot care for themselves because of cognitive impairment. • Examples: psychotic disorders, Alzheimer’s disease, dementia, or other organic brain disorders. Legal Issues: • Legal duty to provide ordinary and reasonable care. • Negligence: unreasonable failure to adhere to professional standards. • Objective Test: What would the average and reasonable helper of similar training and experience have done in the same or similar situation?
Pages to are hidden for
"Crisis Intervention with Suicidal Individuals"Please download to view full document