Assessing a Client's Suicidal RiskHealthcare Training Resource
June 14, 2013 — 1,067 views
The World Health Organization predicts 1.53 million suicidal deaths in the western world by the year 2020. Greater than 90 percent of suicides are attributed to a psychiatric disorder.
When a social worker or other caregiver is treating a patient with major depression, suicide is certainly a concern. The difficulty in predicting if or when an individual is going to commit suicide is due to the patient's unwillingness to discuss their intentions. The way this problem is often dealt with now is to ask the patient, "Do you plan to kill yourself?" Then, if they say yes, they are put into a psychiatric hospital for treatment until the time when they appear to no longer be at risk. The problem is that suicides have a huge spike when these patients are released. Obviously, we cannot believe what the patient tells us about their intentions.
Social workers should receive training to deal with the complexities of working with a suicidal client as there are ethical, legal and psychological aspects. Of course, social workers gather information about their patient's clinical features, and they use this information to formulate a treatment plan. A suicide assessment should always be conducted on a new patient who has a history of mental or a substance abuse disorder, or if the patient has other risk factors.
Magallan Clinical Practice Guideline states there are two components of a suicide assessment.
- "The elicitation and elaboration of suicidal ideation, and
- The identification and quantification of risk factors for completed suicide."
The clinical record should reflect the assessment and any interventions that may be required to manage the suicidal risk.
The APA guidelines have a very comprehensive list of factors associated with suicidal risk. After mental disorders, the greatest risk factors are depression, alcohol abuse, cocaine use and separation or divorce. Previous attempts, particularly in males, are a strong predictor. Violence in the past year also increases their risk. Homosexual youth, bisexual youth and victims of child abuse are all at greater risk. The suicide risk increases for an individual who has been diagnosed with HIV-AIDS.
There are several scales available to assess the risk of suicide, and they each seem to be similar as to assessing the presenting ideation and past suicidal behavior. The immediate ideation of the client with their plans for the future will hopefully open the door to better clinical treatment that prevents suicide.
Psychiatric conditions that include severe depression are a strong indication of possible suicidal ideation. Anxiety was found to be a secondary cause. If this patient has a prior suicide attempt, they are approximately 33 percent more likely to try it again. Clinicians should note a patient's sleep alterations, any increased anxiety and a weight change also.
Studies of Borderline Personality Disorder concluded that three out of four individuals will attempt suicide at some point in their lives. When a social worker senses the patient has a rather sudden sense of calm and happiness following a severe depression, this probably means the patient has a plan to commit suicide.
Social workers must prioritize risk management procedures by keeping current with the literature on suicidal behavior, completing a thorough patient history, which includes any past suicide attempts and to obtain a release to confer with the doctors the patient has seen in the past. Good record keeping with a suicide risk assessment, noting all the risk factors and consulting with other clinicians if necessary are all keys to competent treatment.