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Warning sign
Most suicidal people are extremely ambivalent about their wish to die.
These mixed feelings are usually communicated to friends, or symbolic gestures before an attempt is made.
The majority of individuals attempting suicide (60~85%) communicate their intent through verbal or written means.
Listening the warning signs in difficult as there are so many ranking these signs in order of most dangerous is also difficult because much depends of the personality of the individual, individual history, and the personal meanings attached to events in their lives.
Suicide: Assessing the level of risk
Current suicide plan
Prior suicidal behaviour
Resources
Understanding the crisis
Crisis like symptoms are adaptations or solution to problem
Can he disempowering or self destructive they are still solution
In a crisis feeling overwhelm thinking
To understand the crisis we need to understand the problem it is solving
Approach
Manage the crisis cooperatively
Make the client safer and more in control
Better able to make choices and direct their life
1. Separate the past from the present grounding
2. Help them exercise choice and control
3. Stay connected or repair connection to supportive others
Recognizing and assessing the level of risk
Two important abilities are needed in assessing risk
1. To use warning signs when they are being communicated
2. To judge how dose the person at risk is to suicidal behaviour
Warning signs are ways of saying
“Notice me, I’m in trouble”
forms of commutation vary from individual to individual.
They can be
Biatant such as a note or direct statement, an openly declared plan or an action such as standing on the ledge of a building.
Or
Subtle as in a gesture, a posture, a roundabout comment a tone of voice, or
There are three predictors of immediate risk for suicide.
1. current suicide plan – evidence of a serious plan will include the method, the means, the preparations and think
2. prior suicidal behaviour – If you suspect previous suicide attempts, ask directly about them, what they were, when they happened, how they planned (prepare) to do
3. resource – support systems reduce the risk of suicide – resources can be internal or external and can include. Self-confidence, a positive outlook, hopes for the future, family/friends, access to support service, positive role models.
Suicide: causes and warning signs
Warning signs suicidal threats
Preoccupation with death
Changes in behaviour
Changes in physical condition
Changes in thoughts
Changes in feelings
Stress
Suicide intervention strategies- six tasks for the helper
Engage
Objectives: “give individual a sense of acceptance/support”
“ Look for signs that suicidal intentions are connected to the feelings and events happening in their life”
How: “engage by making into personal”
“Explore what they think/feel from their point of view”
“ Encourage the open expression of concerns/feelings”
Skill: “attending skills”
“Expressive skills”
Identify
Objectives: “to directly identify if person is thinking about suicide”
How: “ask direct question (avoidance and secretly contribute to suicide) gives the person permission to talk about it”, “be specific, are their plane that include means, place etc.
Skill: open/close questions
Inquire (understanding reasons for suicide)
Objectives: “for you and the individual to develop a further understanding of why suicide is being considered now”
“Your emphasis has shifted to finding our as much possible about the individuals struggle.”
Skills: attentive listening, paraphrasing and reflective skills
Assess, Estimate (understanding risk)
Objectives: decide (level of risk based on three predictors
1. Current suicide plan
2. Previous attempts
3. Resources
How: “ask very direct closed question- be specific
Skills: “your estimation of risk will be a combination of intuitive feelings and objective assessment- if you7 have doubt about level of the risk. Err on the side of caution.
Check in often with individual to see if there is agreement on the degree of risk and if the person is ready to consider life-sustaining alternatives.
Contract
Objective: to come up with solutions/strategies that considers sustaining life.
Any plans must have the agreement and cooperation of the individual at risk
There must be freedom to continue discussing suicides
Skills: 1.be specific
2. Limit objectives
3. Mutuality
4. Commitment
5. Crisis support
Follow thought/Implement
Objectives: clearly identify tasks (for you and the individual)
“Make sure you follow through”
“Share tasks- be sure individual can handle their share.”