Crisis Assessment

ClientName:(Character chosen from movie)

ID#:(Not needed)

Date&Time:

Location:Counseling office

Presenting Problem: (Describe thecurrentsituationandconcerns)

Client is a 23-year-oldsinglemalewho has been in outpatient treatmentforfouryears withahistoryof majordepression,recurrent.His familycalledwithconcerns thatthe clientis depressed and withdrawnandis isolatinghimselfinhisroomfor extended lengths of time.

Clientself-reports increaseddepressionover the last 2–3weeks, and a growing sense of hopelessness.Poorsleep,poor appetite,notinterestedinsocializingwithfriends.Feelinghopeless:“Ithoughtitwas overandthatIwas better.I can’tkeepitfromcomingback.Itwouldbebetterfor everyoneifI just wasn’t around anymore.”

Client reports suicidalthoughts forpastthreedays,feels heis aburdento his family, and will never be able to control or manage his depression. He was thinkingabouttakingabottleofTylenolwithabottleofwine.Another clear trigger occurswhen hesees sharpobjects.Hissense of hopelessness has encouraged him to become increasingly isolated from friends and family.

Client has only been able to handle part-time work but is unable to stay employed because of punctuality and attendance issues. Client reports that he has beenoffhisantidepressants for3months now (against medical advice). Client lives with his parents.

Metwithparents whowereverysupportive.After explaining and discussing thesituationwith them,met jointlywithclient.Parents expressedtheirloveandconcernforclientand assuredhimthathewas loved,andnotaburden, and thatdepressionis notanyone’sfault.

ListFactors

RiskFactors

(What cognitions, affect, and behaviors pose a risk to the client’s well-being and to effective treatment/crisis resolution)

· Currentlyexperiencingmajordepressiveepisode.

· Historyofsubstance abusingwhendepressed.

· Currentlyoffantidepressants.Has beenoff antidepressantsfor three months (AME).

· Feels temptedtocuthimselfwhenhesees sharpobjects.

· Ruminatingoverfeelings ofworthlessness.

· Has suicidal ideations butfeels veryconflictedaboutacting upon them.

ProtectiveFactors

(Factors that mitigate the Risk Factors and/or that can be used in treatment)

· Noserious historyofsuicideattempts.

· Has respondedwelltoantidepressants inthepast.

· Good relationship withtherapist.Does not want to hurt family.

· Supportive familyenvironment,andthatis alsotheclient’sperception.

· Willingtocomply with prescribed medications.

· As abaseline,client isresponsibleandhas manypositive

relationships.

· Is ininternalpain, butdoes notwanttodie.

Plan (What can be done to assist this individual as they work through this crisis)

· Client is willing to contract regarding his suicidal ideations. He has agreedtogive hisparents thebottleofTylenolhehas hiddeninhisroom.

· Familywillgetridofthecouple ofbottles of wineinthehome.

· Client agrees thathewillgiveany sharpobjects to hisparents, includingnailfile, scissors, andneedles.

· Familywillremovesharp objects in the home.

· A familymember or friend willbehomewith client atalltimes.

· Client agrees totalktohisparentsifthings getworseor if he feels likehurtinghimself.

· Client hasidentifiedacouple of othersupportivepeoplewho are aware of the situationhewill callifhe feels aneedtohurthimself.

· Perclient’s request, familyagrees tonotkeepaskinghim howheis feeling; this makes himfeelpressured.

· Clientagrees tokeephisbedroomdooropen and to spend more time in other areas of the house.

· Perclientrequest, parents willwatchthenewsintheir bedroomandno scarymovies inthefamilyroom; theywillagree

onappropriateTVshows.

· Clientwilllistento soothingmusiconhisiPodtorelax.

· Clientagrees tojointhefamilyfordinnersnightly; family agrees tonotpressurehimtoeat.

· M.D.restartinghimon (xxxx) andshortterm (xxxx). Parents willbestoringandadministeringthemedications.

· Client willtakedailywalks withmother.

· Familywillprovidereassurances toclientthatheis nota

burden.

· Clienthas signeda releaseofinformationforfamilyand

centerstafftocommunicateabout this crisis.

Referrals/SupportProvided

· Centerphonenumber

· Local suicide line andinstructions for contacting

· Prescriptionforantidepressants andsleepmeds withclientandfamilyeducationonits use and storage

· Medicationeducation(howlong it takes tofeeleffects, possible sideeffects.)

· Safetyplan

Consultations obtainedregardingthis intervention:(Includewhowas consulted,the time,themethod—inperson,telephoneetc.—andthecontentofhis or herfeedback)

Discussedplanwith attending psychiatrist whoalso agreed. Psychiatrist relatedtofamilythatshouldthings getworse,hecouldarrangeadirect admissiontothehospitalunderhis services. Instructions givenforthis. Instructions giventocallifthings getworse and emergency after hours number given. Follow-upappointmentinthreedays withtherapist.

FollowUp (Who will do what and when)

Therapistwillmake follow-upphonecalltoclienttomorrow. Familyandclientgivenemergencynumbers andagree to callcenterorsuicide lineimmediatelyif thingsgetworse. Also gave instructions for seeing the intake worker at the local E.R. Followupappointmentwith M.D. intwoweeks,andcallif things getworse.

Alternatives

Considered (What they are and the reasons they were not selected)

Hospital&Crisis

Shelter

Client doesn’twant inpatient treatment at this time.Says hewants totrycurrentplanfirst. Familyinagreement. Theybothfeeltheseplacements would increasehisanxiety. ProvidededucationoncallingM.D.ifdirect admissiontohospitalmaybeneeded.

Worker (Interventionist’s name)

Your name here