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Suicide Intervention Plan
Allison V. Hobaugh
School of Behavioral Science, Liberty University
Suicide Intervention Plan
Presenting Problem
Karen is a 46-year-old female with a history of depression. She has had three prior
suicide attempts, two being an overdose and one by cutting her wrists. She is seen by a
psychiatrist monthly and is prescribed medication to treat her depression. Although the
medication is prescribed, she is not compliant with it. She finds all her satisfaction in her high
stress job where she works up to 70 hours per week. Karen has no outside interests. She is
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socially isolated and has not dated since her divorce 9 years ago. She came by the outpatient
clinic to inform the office that she appreciates the help and to express how important the staff
and treatment are to her. After further discussion, Karen admits to having a gun in her vehicle.
She does not want to stay and talk but would rather “go for a drive”. Karen is actively carrying
out her plan for suicide and is at immediate risk to herself. She is in urgent need of immediate
intervention to prevent harm to herself.
Precipitating Event
There are several precipitating events to Karen’s depression and subsequent suicide
attempts. She divorced her husband 9 years prior because he had come out to her as
homosexual. 6 years ago, Karen had a year long affair with her sister’s husband. She ended the
relationship due to feelings of guilt. However, the brother-in-law continues to pursue her. She is
also a single mother to a 14-year-old son. Compounding that with her high stress job and no
outside hobbies, she is at higher risk for suicidal ideation and attempts. She is socially isolated,
experiencing high stress at her job, and not compliant with her medications. This may cause her
to experience episodes of suicidal ideations.
Risk Factors
The following risk factors indicate that Karen is a high-risk patient and has an immediate risk of
suicide.
•Karen is a 46-year-old woman with a history of depression. Suicide is the tenth leading
cause of death among people ages 18-65 (Bruns &Barker, 2020).
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•Karen sees a psychiatrist monthly for her depressive symptoms and is prescribed
medication. She is not compliant in taking this medication which can increase thoughts
of suicide (Jackson-Cherry & Erford, 2017).
•Karen unexpectedly stopped by the outpatient clinic to express gratitude to the
counselor for the help received. This is an indirect presentation of a suicidal plan.
•Karen is adamant about not staying to talk with the counselor after confessing to having
a gun in her vehicle. According to the Suicide Risk Assessment Guide, previous suicide
attempts may increase the risk of suicide.
•Karen has had three prior suicide attempts, two by overdose and one by wrist cutting.
This indicates an escalation of attempts with the possibility of attempting more lethal
means of suicide.
•There is no evidence of protective factors in Karen’s life. She is socially isolated, has not
been on a date since her divorce, and works at a high stress job. She has no hobbies
outside of work.
•Divorce, loneliness, and stress are common factors for high risk of suicide (Jackson-
Cherry & Erford, 2017).
•Individuals with a history of depression is a major contributor of higher risk of suicidal
behavior (Fernandez-Rodriguez et al., 2022).
Resources and Protective Factors
Karen disclosed to the counselor that she is in possession of a firearm. This indicates the
urgent need for intervention to deescalate the situation and prevent harm to the client. She is
actively carrying out a suicide plan. In this instance, a Mobile Crisis Team should be called. She
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can get immediate support for the situation and safely remove the firearm from her possession.
There have been studies conducted on the effectiveness of short-term intervention having a
positive effect in decreasing recurrent attempts at self-harm and suicide (Barnhost et al., 2021).
Karen’s job provides her with financial stability but is also her biggest source of stress.
Because of the high stress and long hours of her job, this may be an obstacle to her emotional
well-being and a source of the emotional dysregulation in her life. Karen’s place of employment
may have access to Employee Assistance Programs (EAP) that offer workshops on stress
management, self-care, and wellness activities. She should be referred to the program to utilize
this resource.
Karen can seek support from her family but is hindered by her feelings of guilt
associated with the affair with her sister’s husband. She can attempt to make amends for that
with her sister and emphasize that it has ended. This will not be an immediate protective factor
in her case and may require more counseling to include her sister in some sessions. Although
she works at a high stress job, she can look to her colleagues for support. She has stated that
she finds high job satisfaction so this can be beneficial as a resource.
Spirituality
Ethical Considerations
The American Counseling Association (ACA) has guidelines that assist counselors when
dealing with a client that is immediate need of intervention. A counselor must take appropriate
steps to ensure the safety of the client and others (Section B.2.a). Informed consent as
addressed in the ACA Code refers that clients must be informed of all potential effects of
entering into a therapeutic relationship (Section A.2.a). There are exceptions to the rule of client
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confidentiality. Imminent harm to oneself and/or others is one of these exceptions (Section
B.2.e). Counselors are directed to report these cases through the proper channels. The ACA
Code of Ethics also covers assessments of risks and making diagnoses in Section E.1.a.
The American Association of Christian Counselors (AACC) has similar situations covered
under their Code of Ethics. A counselor’s first and foremost duty to the client is to protect them
from harm. If harm is assessed, immediate action must be taken to prevent it. The counselor
must be confident and competent to know how to deescalate a high-risk situation utilizing the
proper tools, resources and techniques available.
Spiritual Considerations
The beliefs of the client are important to consider. In the scenario of Karen, it is not
evident what her spiritual or religious beliefs are. Beliefs that are spiritually and religiously
related can both protect against and contribute to an individual’s suicidal thoughts, depending
on perception (Amiri et al., 2023). There are many religious schools of thought that either
discourage or condemn the act of suicide. Those with a spiritual belief system attribute purpose
and meaning of life and a sense of community to those beliefs. Biblically speaking, the truth of
the sanctity of life is emphasized as a gift from God and should not be squandered. Humans are
made in His image as stated in Genisis 1:27 “So God created mankind in His own image, in the
image of God He created them; male and female He created them”.
Suicidal ideations usually stem from a feeling of loneliness and hopelessness. The client
may feel abandoned by all who care about them. The Bible tells us in many ways that we are
not alone. Isaiah 41:10 states “Do not be afraid, for I am with you. Do not be discouraged, for I
am your God. I will strengthen you and help you. I will hold you up with my victorious right
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hand.” This scripture speaks to those who feel alone and abandoned. God will never abandon
us, it is written. Biblical principles like the unconditional love of God (Romans 8:38-39) and
forgiveness (1 John 1:9) can help believing clients overcome the feelings of unforgiveness and
loneliness. It is important to incorporate the client’s beliefs into their treatment plan.
Interventions
•Encourage Karen to remain in the office to talk and for safety concerns
•Contact law enforcement to retrieve the weapon from her vehicle
•It is important to use a calm, non-threatening tone and movements
•Validate her feelings and concerns
•Confirmation of suicidal ideation
•Suggest family support
•Coordinate with mobile crisis center
•Establish a 24-hour no harm contract (can be verbal)
•Coordinate with Karen’s psychiatrist with her consent
•Identify and implement coping strategies
•Schedule follow-up appointment to assess progress for the next day
•Provided crisis hotline information
Treatment Plan: Goals and Interventions
Problem 1 (mental): Karen is experiencing severe depression, compounded by deep persistent
sadness, lack of interest in hobbies outside of work, social isolation and recent suicidal ideation.
Goal 1: Reduce depressive symptoms and minimize thoughts of suicide over a 12 week
period.
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Objective 1: Karen is directed to attend weekly sessions with the outpatient
clinic. The use of cognitive-behavioral therapy (CBT) and mindfulness exercises
will manage depressive thoughts.
Intervention 1: The counselor will use CBT techniques to help the client
pinpoint negative thought patterns. The use of mindfulness exercises will
give Karen the tools needed to counteract those thoughts. Progress will
be marked weekly with a focus on decreasing thoughts of suicide.
Problem 2 (physical): Karen is presently not compliant with her medication prescribed by her
psychiatrist. This has contributed to the increased thoughts of suicide as well as a decline in her
mental health.
Goal 2: Improvement of compliant medication use to support mental and physical
wellbeing.
Objective 1: Karen will adhere to taking her medications daily. Compliance
should be monitored through self-report and through communication with her
psychiatrist.
Intervention 1: Collaboration with the psychiatrist to ensure her
adherence to the medicine protocol, address concerns (side effects) and
adjust according to the needs of the client.
Problem 3 (emotional): Karen has struggles with stress management and regulations of
emotions.
Goal 3: Enhance emotional regulation through journaling and mindfulness exercises.
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Strengthening coping skills to help manage triggers and reduce suicidal ideation.
Objective 1: Karen will be given mindfulness exercises to practice daily.
Exercises such as relaxation breathing, muscle tension/relaxation will be used.
Daily journaling will also help Karen identify negative thought patterns. Weekly
reports in sessions by Week 6 of treatment plan.
Intervention 1: Training in mindfulness techniques such as guided
mediation will be provided by the counselor. The counselor will
encourage Karen to write daily in the journal and practice mindfulness to
help manage emotional dysregulation.
Problem 4 (social): Karen feels isolated from others. Her only social interaction is through work,
contributing to increased depressive thoughts.
Goal 4: Increase social engagement and encourage a stronger support system to reduce
feelings of isolation and depressive thoughts.
Objective 1: Karen will attend one social event weekly. Examples of this can be a
weekly depression support group, having coffee with a friend outside of work by
Week 9 of the treatment plan.
Intervention 1: The counselor can assist Karen in identifying social
activities based on her interests. The counselor will check in at weekly
session with Karen to inquire about the progress and her experiences in
building connections with others.
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Problem 5 (spiritual): Karen has not explored her beliefs in depth which could provide a sense
of belonging and purpose. Having such beliefs can help decrease her feelings of isolation and
depressive thoughts.
Goal 5: The counselor will help Karen explore and identify what her personal beliefs are.
This will provide a stronger layer of emotional support and give her a sense of purpose.
Objective 1: Karen is encouraged to engage in daily mediation and self-reflection
for at least 15 minutes. She is encouraged to report her experiences in at least 4
sessions by Week 10.
Intervention 1: The counselor and Karen will have discussions about what
her specific beliefs are and with that knowledge, the counselor will
provide some resources such as guided meditation or spiritual readings.
References
American Association of Christian Counselors, Clinton, T.E., Scalise, E., Jenkins, D., Nichols, K.,
Ohlschlager, G., Maxon, J., & Sandy, J., (n.d). AACC-Y-2014 Code of Ethics.
https://www.aacc.net/wp-content/uplaods/2020/06/AACC-Code-of-Ethics-Master-
Document.pdf
American Counseling Association. (2014). ACA Code of Ethics.
https://www.counseling.org/docs/default-source/default-document-library/ethics/
2014aca-code-of-ethics.pdf?sfvrsn+55ab73d0_1
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Amiri, S., Mohtashmi, J., Memaryan, N., & Vasli, P. (2023). Spiritual needs of people with suicidal
ideation: a qualitative study. Current Pyschology, 43(2), 1359-1368.
https://doi.org/10/1007/s12144-023-04424-4
Barnhorst, A., Gonzales, H., & Asif-Sattar, R., (2021). Suicide prevention efforts in the United
States and their effectiveness. Current Opinion Psychiatry, 34(3), 299-305.
https://doi.org/10.1097/yco0000000000000682
English Standard Version Bible. (2001). ESV Online. https://esv.literalword.com/
Fernandez-Rodrigues, V., Sanchez-Carro. Y., Lagunas, L. N., Rico-Uribe, L. A., Pemau, A.,
Diaz-Carracedo, P., Diaz-Marsa, M., Hervas, G., & De La Torre-Luque, A., (2022). Risk
Factors for suicidal behaviour in late life depression: A systematic review. World
Journal of Psychiatry, 12(1), 187-203. https://doi.org/10.5498/wjp.v12.i1.187
Jackson-Cherry, L., & Erford, B. T., (2023). Crisis Assessment, Intervention, and Prevention
(4th ed.). Pearson Education.
https://mbsdirect.vitalsource.com/books/9780138039202
Klott, J., & Jongsma, A. E. (2015). The suicide and homicide risk assessment &
prevention treatment planner (2nd ed.). John Wiley & Sons.
Kolski, T. D., Jongsma, A. E., & Myer, R. A. (2015). The crisis counseling and traumatic
events treatment planner (2nd ed.). John Wiley & Sons.
