Suicide Assessment and Prevention

Suicide Assessment and Prevention

Shelley LeMaster, BA

COUN-6013 Internship 1

Summer 2023

Case Vignette

Sidney, 79, shifts uncomfortably in the recliner in the living room. A walker is propped against the arms of the chair. The pain in his legs has gotten progressively worse in recent months. Sidney says it’s getting “harder and harder to get around.” After his wife died last year, he moved in with his daughter for a few weeks. His wife’s death devastated Sidney who assumed he would be the first to go. He says things have not gone “according to plans.”

Sidney says he is a “burden” to the family. “They don’t have to say anything,” he says, “ I can just see it….

Who wouldn’t resent having to babysit an old man who can hardly even get his own dinner?”

Sidney is back in his own home again, but he’s not sure how long. And, after living with his wife for 50 years, he is lonely and finds himself unable to control his emotions. In a matter of weeks, Sidney went through the couple’s liquor supply and has taken to ordering home delivery of new supplies every couple of days.

Sidney admits that he sometimes thinks killing himself would be the best thing. That way no one would have to “be bothered with me anymore.” He considers taking enough sleeping pills to “put myself to sleep forever.”

Ethics, Laws, and Risks

Making ethical decisions in determining which appropriate course of action to take when faced with a problematic ethical dilemma can be challenging. Barnett and Johnson (2010) propose that the first step should include articulating the problem and gathering as many relevant facts and details as possible. This allows counselors to not only identify the main areas of interest, but also to begin considering the ethical issues at hand and any obligations they may have (Barnett & Johnson, 2010) In Sidney’s situation it is a common problem among older adults and in particular older men. Risk factors for suicide in older adults include the loss of a loved one, loneliness and physical illness. Suicide in older adults is often attributed to the development of depression due bereavement or loss of physical health and independence. When counselors realize that they have reached an ethical dilemma, they can choose to consult an ethical decision-making model to help with this processThe ACA code most relevant to Sidney’s situation would be ethical obligation to break confidentiality. Counselors can break confidentiality in situations where clients might harm themselves or an identified other (ACA, 2014, B.2.a.). The decision for Sidney to end his life can also affect his entire family. In the decision making model process, I would evaluate the decision, consult the supervisor, and act on my values. I feel I have the duty to take “reasonable” or “appropriate” steps to prevent the suicide.

Personal Thoughts and Feelings About Suicide

It is vital for counselors to be aware of “their own values, attitudes, beliefs, and behaviors” (ACA, 2014, A.4.b., p. 5), so that they can avoid these affecting their relationships with clients. In my personal opinion it is not our place to decide when we should die. I feel deciding our own fate is a sin against my religion and against the wishes of our creator. At times we feel hopeless but if we gain strength and the commitment to live on through our struggles, we will one day fulfill our purpose. I hope I would be able to give Sidney a reason to find hope.

Professional Assistance

I would seek professional assistance from my supervisor, coworkers, and other valued professional therapists I have worked with. My coworkers may also be aware of the situation. Counselors must also seek consolation according to the ACA Code of Ethics H.2.d when uncertain of a particular that might

violate one of the ACA Code of Ethics.

Acceptance, Understanding, and Non-Judgmental Stance on Suicidality

To ensure Sidney’s well-being, my priority would be to refrain from getting emotional about the situation. I will provide Sidney with a safety plan in his treatment planto ensure Sidney’s independence while he is at his own home and longevity.

Risks and Protective Factors

Since documentation would need to be gathered in defense of malpractice, providing that a professional relationship existed between therapist and client. During the intake process, I would begin by having Sidney sign consent forms, take assessments, and do an in-depth biopsychosocial. I would include a physical health history, mental health history of Sidney and his family, substance abuse history, trauma history, and history of suicidal ideation and self-harm. In his trauma history, I would assess his witnessed and experienced childhood trauma. I would do a suicial assessment on Sidney for suicidal and homicidal ideation. I would also research statistics about Sidney’s specific culture relating to suicide, making sure I do not miss any cultural beliefs he has about suicide.

Assessment

At the beginning of the assessment, I would have Sidney sign all consent forms and review the forms of consent. After creating an episode for the client, I would administer a suicide assessment, the C-SSRS (Columbia et al.). I use this assessment because it is simple; the client and the counselor can understand it. This assessment uses precise wording that assesses the attempts, thoughts, and history of suicidal attempts, and a risk assessment scale. ( Internian, 2018). I would continue administering the C-SSRS weekly until Sidney’s level of suicidal ideation is lower based on the current clinical judgment of where Sidney is during each session. After each, I would discuss the results with Sidney, making the necessary changes to his safety plan.

Client Name: Sidney Rogers

Session Date: 6/16/23

Session Number:1

Type of Session

Nature of Contact

X

Individual

X

Scheduled Appt.

Group

Walk-In

Couples

Emergency

Families

Diagnosis

293.83 (F06.32) Major Depressive Disorder

Differential Diagnosis

F31- Bipolar Disorder

F31 9 Bipolar I

Subjective

Sidney is a 79-year-old Caucasian male. Sidney presented to counseling because he has been suffering from the loss of his wife followed by failing health problems. Sidney presents the session as poorly groomed, with poor hygiene and wrinkled clothing. Sidney has an appropriate level of alertness, is oriented x-3, and presents with normal consciousness. He appeared to have a guilt content, evidenced by a self-report of “ I am a burden to my family, Who wouldn’t resent having to baby sit an old man who can hardly even get his own dinner?” His mood and affect appear dysphoric, evidenced by low energy, lack of eye contact and not smiling. Sidney’s mood currently exhibits signs of depression, fear, and anger.

Sidney expressed feelings of hopelessness since his wife passed away last year. He reported feelings of guilt due to having to move in with his daughter for a few weeks. Sidney admits that he sometimes thinks killing himself would be the best thing. The client stated,” that no one would have to “ be bothered with me anymore”. Sidney reported the pain in his legs have gotten progressively worse in recent months. Sidney reported,” it’s getting harder and harder to get around”. Sidney is now back at his own home but Sidney stated, he isn’t sure how long he will be able to stay at home”. Sidney also discussed being emotional and lonely. Sidney stated, “ after living with his wife for 50 years, he is lonely and finds himself unable to control his emotions”. Sidney reports no hallucinations or delusions.

Objective

Sidney expressed feelings of hopelessness. Sidney expressed wanting to kill himself and has stated he considers taking enough sleeping pills to,” put himself to sleep forever”. When I talked with Sidney about how he felt his daughter would feel about this, he reconsidered when he realized she would feel the

same way he does now being the only child.

Assessment

The client presents with current suicidal ideation based on his statements, and a safety plan will be indicated. Sidney will be given an assessment using the Columbia Suicide Severity Rating Scale. The results of his assessment will be discussed with him. ( See attached Safety Plan for Details).

Plan

The client and therapist will mutually agree on a treatment plan and safety plan. Sidney will continue with weekly individual sessions.

____________________________ _____________________________

Counselor-in-Training Supervisor Signature

Safety Plan

Warning Signs:

Isolating from others

Not participating in the session

Not showing up for appointments

Short-Tempered

Coping Skills

Talking to family

Talking with Friends

Reading

Activities at the senior citizens center where he is a member

Places I can go or where people can distract me from myself or my problems

The senior citizens center

The lake

Museum

Family and Friends I can contact during a crisis

Daughter and her family

Members whom I am friends with at the Senior Citizens acenter

Neighbor

Professional/Agencies that I can contact during a crisis

Suicide Prevention Hotline 1-800-273-8255

Mountain Comprehensive Crisis Line 1-800-422-1060

Steps I will take to ensure my environment is safe

Remove all guns

Remove all sharp instruments

Have positive affirmations in several locations

Things that are important enough in my life for me to want to not hurt myself

My Daughter

My grandchildren

Religion

_______________________________________________________________

Electronic Signature provided by Counselor Shelley LeMaster

_______________________________________________________________________

Electronic Signature provided by the client, Sidney Rogers

Treatment Plan

Student Name: Shelley Lemaster

Date:6-15-23

Client Name: Sidney Rogers

Presenting Problem: Sidney presents with bereavement lasting longer than one year. Major depressive disorder by the presence of depressed mood or marked loss of interest or pleasure in activities. Sidney presents feelings of loneliness, guilt, fear, and anxiety. His depressive symptoms have been present for longer than a month.

Diagnosis and Specifier: Include DSM and ICD 10-CM Code: 296.20 -F33.0 Depressive disorders are not due to another medical condition.

Treatment Procedures

1. Mode of Therapy-Individual

2. Session- Weekly

3. Number of expected sessions ( Including this week)-28

Problem 1: Suicidal Ideation

Goal 1: Alleviate the suicidal impulses/ideations and return to the highest level of the previous daily function.

a Objectives Projected Date Clinical Intervention

6-16-23 Work cooperatively with the 9-16-23 Establish rapport with the client

therapist toward agreed-upon toward building a solid therapeutic therapeutic goals while being alliance; convey caring and empathy; open and honest as comfort provide non-judgemental support and

and trust allow. develop trust with the client to develop

a safe place to discuss suicidal thoughts, feelings, and actions and the impact upon his life.

6-16-23 Honest sharing thoughts of 9-16-23 Assess the client’s suicidal risk,

suicidal thoughts, feelings, and including the extent of his ideation, the

actions, which include planning presence and feasibility of a plan

and intent. means, family history and other risks and protective factors.

3-16-23 Disclose any history of 9-16-23 Conduct or arrange for a substance use

substance use that may evaluation and refer to the client for

contribute to and complicated treatment if the evaluation treatment. recommends it.

Problem 2: Depression

Goal 1: Recognize, accept, and cope with feelings of depression.

Goal 2: Develop healthy thinking patterns and beliefs about self, others, and the world that lead to the alleviation and help prevent the relapse of depression.

Date

Objectives

Projected Goal Date

Clinical Intervention

6-16-23

Work cooperatively with the

therapist toward agreed upon

therapeutic goals while being

open and honest as comfort

and trust allow.

9-16-23

Strengthen influential

relationship factors within the

therapy process and foster the

therapy allicance through

paying particular attention to

those empirical support

factors; work collaboratively

with the client in the treatment

process; reach agreement on

the goals and expectations of

therapy; demonstrate

consistent empathy towards

the clients feelings and

struggles; verbalize positive

regard toward affirmation of

the client and collect and

deliver client feedback as to

the client’s perception of it’s

progress.

6-16-23

Describe current and past

9-16-23

Assess current and

past

Experience with depression.

Including their impact on

functioning and attempts to

resolve it.

9-16-23

Mood episodes, including their

features, frequently, severity,

and duration.

6-16-23

Idenify and replace thoughts

and beleifs that support

depression.

C

onduct cognitive behavioral

therapy, first conveying the

connection among cognition

depressive feelings, and

actions.

Problem 3: Provide a Safe Environment

Goal 1: Will Create A Safe Environment

Date

Objective

Projected Goal Date

Clinical Intervention

6-16-23

Work cooperatively with the

therapist toward agreed upon

therapeutic goals while being

open and honest as comfort and

trust allow.

9-16-23

Continue Weekly Individual

Sessions

6-16-23

Committing

removing

to

weapons or the means of

suicide attempts from the

environment.

9-16-23

The therapist will recommend

storage options that are

amenable to the client’s

different types of firearms.

6-16-23

Identify irrational, negative

beliefs

9-16-23

Assist the client in recognizing

that the associated negative self

talk

contributes

to

the

difficulties that they are

currently experiencing.

Reference

Barnett, J. E., & Johnson, W. B. (2010). Ethics Desk Reference for Counselors. Alexandria, VA: American Counseling Association

American Counseling Association. (2014). ACA Code of Ethics. Retrieved from HTTPS://www.counseling.org/resources/aca/aca-code-of-ethics.pdf

American Psychriatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders DSM-5.

Interian, A.C. (2018) Use the Columbia Suicide Severity Rating Scale (C-SSRS) to classify suicidal behaviors. Trtrieved from the Archives of Suicide Research,22 (2), 278-294: HTTPS://dpo/prg/10.0180/13811118.2017.1334510

Michael Griffin, J.L. ( 2022,March, April). Working with Suicidal Clients. Retrieved from CAMFT:

HTTPS://www.camft.org/Resources/Legal-Articles/Chronological-Article List/working-with-suicidalclients.

1Suicide Assessment And Prevention Portfolio

1Suicide Assessment And Prevention Portfolio

1Suicide Assessment And Prevention Portfolio

12 Suicide Assessment And Prevention Portfolio