Preventing Suicide A Guide For Professionals And Care Givers

Preventing Suicide A Guide For Professionals And Care Givers



One of​ the greatest failures of​ counselors and caregivers of​ persons with mental health problems is​ becoming complacent in​ attending to​ the urgency of​ our clients' situation. We get used to​ the depression waxing and waning and the periodic crises. We get desensitized to​ the constant crises of​ our patients with borderline traits. We get lax when our depressed patients start to​ come out of​ their depression, when in​ fact, this is​ when they are most likely to​ commit suicide. These are all common reasons that patients seemingly commit suicide with no warning. as​ a​ clinician and/or guardian of​ someone who is​ depressed or​ has bipolar disorder, there are several things you can do to​ prevent unnecessary tragedy.

It is​ simple to​ increase our effectiveness with the ABC(DEF)s. a​ is​ for assessment. a​ mental health assessment needs to​ be conducted and documented at​ each contact. B is​ for believe. it​ can be tempting to​ dismiss emotional upset as​ "just another passing crisis" but it​ is​ this attitude that prevents us from helping people stay alive. C is​ for consult. When you have a​ client in​ crisis, have a​ colleague you can consult with. They are less likely to​ miss subtle changes in​ the client's presentation and can provide unbiased advice. Additionally, it​ is​ good practice at​ the beginning of​ a​ relationship to​ get a​ release to​ speak with the patient's physician. in​ the event that he or​ she is​ medication noncompliant or​ using alcohol or​ other drugs with prescribed medications in​ a​ way that is​ dangerous (i.e. taking Risperdal and 1/5 of​ rum), it​ is​ important to​ consult with the patient's prescribing physician. D stands for document. Every single progress or​ contact note must include evidence that you completed at​ least a​ mini mental status exam. E is​ for educate. Equip your clients with tools to​ help them get through crises and deal with triggers. This includes emergency numbers, life pact/crisis action plan, cognitive behavioral interventions to​ get through an​ acute situation and information about the dangers of​ any medication noncompliance or​ other risky behaviors. Finally, F is​ for follow up. if​ a​ patient misses an​ appointment, it​ is​ best to​ follow up that same day, but at​ least within 24 hours and document that effort. When patients call or​ present in​ crisis is​ is sometimes appropriate to​ follow up with them 24 hours after the contact to​ see how they are doing. in​ some extreme cases, a​ follow up may include a​ well being check by law enforcement.

Let's look at​ these a​ little more closely. First and foremost, regularly assess the person's mental status. Are they alert or​ confused? Can they make decisions? is​ there any change in​ eating or​ sleeping patterns? Do they talk of​ suicide, hopelessness? Do they seem apathetic---not really enjoying anything? Additionally, there are several key warning signs for suicide. First, Do they have future plans? if​ they are talking about a​ vacation, an​ upcoming holiday or​ even plans for tomorrow, it​ is​ a​ good sign. Also, are they giving away and/or making arrangements for the care of​ their children/pets? People who see suicide as​ immanent will usually be making arrangements for those people and creatures that are dependent on them. Each time you meet with the person, you should assess these things. if​ you are a​ caregiver/guardian, just do a​ quick assessment in​ your head. if​ anything seems amiss, get the person in​ for a​ formal evaluation. if​ you are a​ clinician, this evaluation must be a​ part of​ every progress note. it​ is​ even a​ good practice to​ do a​ mini mental status exam (and document it) each time the person calls, especially if​ it​ is​ due to​ a​ crisis or​ to​ cancel an​ appointment.

There are also other factors that can help to​ mitigate/prevent suicide. For one, pay attention to​ the patient's triggers. For some people it​ is​ a​ holiday, for others it​ might be the anniversary of​ the death of​ a​ loved one or​ a​ pet and still for others it​ might be a​ situation that reminds them of​ a​ trauma in​ the past such as​ news coverage of​ a​ disaster, seeing a​ bad traffic crash etc. When these times are coming up, at​ least part of​ your sessions leading up to​ the trigger time should involve preparation for dealing with any feelings that arise. Devise a​ safety plan. For patients who might be triggered by a​ situation such as​ a​ traffic crash, these preparations should take place in​ the beginning of​ therapy. This way, whenever they run into a​ trigger they have some tools to​ deal with it. Another responsibility we as​ clinicians have, whether we take insurance or​ not, is​ to​ ensure the person has access to​ an​ emergency appointment (phone or​ face to​ face) within 24-hours of​ going into crisis. Since patients do not always call us when they go into crisis, it​ is​ a​ good practice to​ follow up with patients within 24 hours of​ a​ missed appointment.

Finally, many clinicians feel hamstrung about the issue of​ reporting patient medication noncompliance. For many patients, medication noncompliance (either monkeying with dosage or​ using alcohol or​ drugs with their medication) is​ life threatening. There is​ not currently case law that I know of, but a​ clinician that knowingly allows clients potentially create a​ deadly cocktail by mixing alcohol or​ drugs with certain medication potentially could be held liable for failure to​ protect a​ person in​ imminent danger. For many patients, medication noncompliance is​ their way of​ indicating that their medications need to​ be adjusted. in​ the beginning of​ therapy, I have patients sign a​ release allowing me to​ talk with their physician. There are a​ multitude of​ reasons that the physician may need to​ be consulted, so this is​ helpful. I do however make a​ pact with my patients that I will tell them before I call their doctors. if​ during therapy I find out they are noncompliant I have my patients sign an​ agreement that outlines the dangers of​ their medication noncompliance, states they will stop doing what they are doing, will notify their doctor and will bring back proof of​ that notification to​ me. I follow up with the patient each session on this issue until the issue is​ corrected. it​ is​ an​ art to​ handle this in​ a​ way that does not push the patient away, but lets them know you are genuinely concerned.

Since crises will come up despite your best efforts, it​ is​ advisable to​ do a​ life pact at​ the first session with patients who are severely depressed, have bipolar disorder or​ evidence a​ personality disorder. This life pact should contain emergency contacts, information about the availability of​ weapons, directions to​ the person's house, a​ contract to​ go to​ the emergency room or​ call 911 before they harm themselves, the number to​ the local crisis center and a​ notification statement to​ the person that if​ you feel they are in​ immanent danger you will be sending law enforcement to​ do a​ well-being check.

If you employ all of​ these techniques, you will be much less likely to​ have to​ experience the loss of​ a​ patient or​ loved one who is​ under your care.




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