When someone admits to Suicidal Ideations...
When someone admits to suicidal ideation …
The conversation begins … but it is not your signal begin taking action. Action comes only after listening very carefully to what the person is saying. It is the beginning of your chance to learn about the person involved in the intervention.
Most people have had a suicidal ideation at some point during their lifetime.
Whether it be something as simple as “I wish I were not here”, or something direct, “I want to kill myself!”; this type of thought is not unusual for any person.
In order to begin assessing an individual for the risk of suicide you need to step beyond the primary statement and begin asking direct questions.
Questions need to be direct, because the person is discussing a TABOO subject with you and you need to communicate clearly to them that you hear them.
You need to let them know you understand they are hurting and you are taking them seriously.
This is not the time you begin "beat around the bush".
When someone makes a suicidal statement to me, my first response is, “How would you do it?”
What I am looking for here is to understand the complexity, specificity, and the amount of energy they have put into the plan.
For example; if you tell me you are planning to shoot yourself and further questioning reveals that you do not own a gun and do not access to a gun, I would downgrade the immediate seriousness of the situation.
If you tell me you would jump off a bridge and you live near a couple of high bridges, I would upgrade the immediate seriousness of the situation.
If you explain a complex plan and indicate you spent a great deal of time researching the plan on the Internet, through books and/or journals, you also have increased my perception of your level of severity.
Once I have asked enough questions to determine the severity of the plan, then I begin to ask about timeframes for implementation of the plan. Some people have very definite timeframes while others have vague, diffuse plans. The more specific the time frame or the closer the time frame, the more severe you should rate the situation. Also, very vague, “I don’t really know” plans when you are dealing with a traumatized or depressed person, should elevate the seriousness as well.
Often times people have specific dates, anniversaries, and timeframe in which the plan is set.
I recently dealt with a gentleman who stated to a coworker they intended to kill themselves on their 71st birthday.
The coworker, non-mental health practitioner was arguably distraught.
My first question when is his birthday.
The date they gave me 3 1/2 months away.
My next response was, "well we have a little time to sort this out."
This may seem cold at first, but when assessing suicide risk you need to be very rational. When you are doing a suicide assessment, you need to the calmest person in the room.
If you get excited everybody else will get excited.
It doesn't really matter how nervous, upset, or excited you truly are, it is essential that you show absolute calm.
Another example:
I was assessing a man who presented with a plan of committing suicide by laying on a train track and having a train run him over. Further questioning indicated that he was living in a house whose back yard was bordered by a train track which had at least two trains passing every day.
This is a suicidal ideation with a plan that is easily carried out and almost impossible to stop.
This person would always be at elevated risk for attempting suicide.
Always remember the more specific plan, the more detailed plan, the more thought out the plan, the more research the plan, the greater severity you should rate the possibility of a suicide.
We'll discuss the difference between chronic risk factors and acute risk factors.
No suicide risk assessment is complete without an understanding of the difference between these two sets of risk factors.
Check out our free Suicide Risk Assessment on our HomePage!