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Suicide Ideation and plan vs no Plan. Aka: Do I take this serious? Dr Lisa Arieta Hayes. California State Law. We are required to report suspected: Physical abuse Sexual abuse Serious neglect Suicidal ideation with intent Homicidal ideation with intent. Risk Assessment for suicide.

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suicide ideation and plan vs no plan

Suicide Ideation and plan vs no Plan

Aka: Do I take this serious?

Dr Lisa Arieta Hayes

california state law
California State Law
  • We are required to report suspected:
    • Physical abuse
    • Sexual abuse
    • Serious neglect
    • Suicidal ideation with intent
    • Homicidal ideation with intent
risk assessment for suicide
Risk Assessment for suicide
  • Age
  • Sex
  • Stress
  • Symptoms
  • Prior Suicidal behavior
  • Current degree of planning
  • Resources
suicide risk by age and gender in california
Suicide Risk by Age and Gender in California
  • Female Youth
    • Most at risk ages 15-19
  • Male Youth
    • Most at risk ages 20-24
  • Female Adults
    • Ages 50-59
  • Male Adults
    • Ages 70 years and above
clues to suicide
Clues to Suicide
  • Helpless/hopeless
  • Anger or fighting
  • Insomnia or hypersomnia
  • Self inflicted injuries
  • Giving away belongings
  • Developing will and/or saying goodbye
  • Making threats to kill self/others
more clues
More Clues
  • Unrealistic guilt
  • Isolating from friends and family
  • Resentment and hate
  • Increased alcohol and drug abuse
  • Poor appetite or overeating
  • Poor self care and hygiene
  • Crying
  • Poor health
suicide assessment
Suicide Assessment
  • Intent
    • The client makes verbal statements
      • “I wish I was dead”
      • “I want to die”
      • “I’m gonna kill myself!
    • The client has thoughts
      • “I can’t go on”
      • “I’m in too much pain but I can’t tell anyone”
  • Passive intent – no real plan
    • “I want to die but haven’t thought how I would do it”
    • “I just wish a car would hit me”
    • “I wish I just wouldn’t wake up”
    • Clue is person has No Active Plan
assessment
Assessment
  • Plan
    • Time line of when
      • E.g. anniversary of husband’s death
    • How
      • Pills, gun, hanging etc…
    • Where
      • At home after everyone leaves
    • The client shares a clear plan then 5150
    • The client has no plan – then no harm contract and constant monitoring
      • Check in each time you see them and renew each week
assessment1
Assessment
  • Lethality
    • Method will likely result in death
    • Has easy access to the method
    • In possession of the method
    • Not lethal e.g. jump out of plane, take birth control pills
  • History of previous attempts
    • Must get details of each attempt and what happened e.g. took bottle of aspirin, hospitalized, stomach pumped
    • No as serious attempts e.g. superficial cuts; taking medication that is not lethal or not taking enough e.g. took 2 valium
assessment2
Assessment
  • Contracting
    • Contracts does not mean a client will not commit suicide
    • Even is a client signs a contract it does not mean that they will not change their mind
    • Contracts represent good faith effort and agreement of client with you to work together on this problem
    • Important to have with clients who have no plan but often has thoughts of suicide/death
contract
Contract
  • Includes agreement not to harm self
  • Promises not to harm self unless contact therapist, crisis/suicide hotline, or agency’s 24 hour answering services first
  • Time limited
  • Reviewed and documented constantly
  • Agencies usually have boiler plates to use – ask your supervisor for a copy or where to find on agency shared drive
so what do i do
So What do I do??
  • Find out protocol for your agency
  • Seek out policy and procedure with supervisor
  • Review no harm contract
  • Seek out supervision IMMEDIATELY when you have any questions regarding suicide