Case Study 6 (continued)
Rationale for Question 1: The best option is B. The stressor in Ella’s life was the breakup with her boyfriend of three months. Rationale for Question 2: The best option is D. Removing the bottle of Tylenol from Ella’s possession and ensuring that she does not have access to other means of poisoning could have reduced the potential for follow-through by Ella. Rationale for Question 3: The best option is D. Although there is no definitive means of absolutely ensuring that a suicide can be prevented, conducting an appropriate assessment, and developing a plan that includes patient and family is mandatory. In addition, ongoing follow-up is essential as well. Patients at risk for suicide must receive follow-up, as well as extensive education. Family members must also receive education and training on an ongoing basis. Discussion: Managing and treating suicidal ideations can be challenging, especially in children whose parents are dismissive of the warning signs in their children. The counselor, in this case, reacted appropriately by promptly reporting her findings and suspicions to Ella’s parents. However, Ella’s mom’s denial regarding the challenges her daughter faced was a particular hindrance in securing the right help for Ella. Education regarding lethal means is imperative for all involved. Limiting or reducing Ella’s access to lethal means (Tylenol) could have effectively prevented her death by suicide. This restriction to access may have resulted in her using a substitute or delaying the attempt. Either the substitution or delay would have provided time to pass and potentially the crisis to pass, which would have resulted in an unsuccessful attempt or no attempt at all. The counselor should have tried to contact Ella’s father and convey her sense of urgency regarding the immediacy of Ella’s needs. This was especially important, given that her mother was so resistant to getting Ella the help she needed. After Ella’s death, her friends and classmates should receive counseling. Additionally, Ella’s parents should receive grief counseling to help them cope with the loss of their daughter.
2. Suicide-Specific Therapy Approaches a. Dialectical Behavioral Therapy (DBT). https:// behavioraltech.org/ b. Cognitive Behavioral Therapy (CBT). https:// sprc.org/event-training/cognitive-behavioral- therapy-for-suicidal-behavior/ c. Collaborative Assessment and Management of Suicidality (CAMS). https://cams-care.com/ d. Problem-Solving Therapy (PST). https:// aims.uw.edu/training-support/behavioral- interventions/problem-solving-treatment-pst e. Attachment-Based Family Therapy (ABFT). https://drexel.edu/familyintervention/ attachment-based-family-therapy/overview/ 3. Involving family and other supports a. The Way Forward. https://theactionalliance. org/sites/default/files/the-way-forward- final-2014-07-01.pdf b. Family-to-Family Educational Program. https:// www.nami.org/Support-Education/Mental- Health-Education/NAMI-Family-to-Family c. Suicide is Different. https://www. suicideisdifferent.org/ 4. Safety planning a. Safety Plan Treatment Manual to Reduce Suicide Risk: Veteran Version. https://sprc.org/online- library/safety-plan-treatment-manual-to-reduce- suicide-risk-veteran-version/ b. Patient Safety Plan. https:// suicidepreventionlifeline.org/wp- content/uploads/2016/08/Brown_ StanleySafetyPlanTemplate.pdf c. Safety Planning Guide: A Quick Guide for Clinicians. https://sprc.org/online-library/safety- planning-guide-a-quick-guide-for-clinicians/ d. SAMHSA Suicide Safe Mobile App. https://store. samhsa.gov/product/suicide-safe 5. Lethal means counseling a. Recommendations for Clinicians. https:// www.hsph.harvard.edu/means-matter/ recommendations/clinicians/ b. Recommendations for Families. https:// www.hsph.harvard.edu/means-matter/ recommendations/families/ c. Counseling on Access to Lethal Means (CALM). https://dev.sprc.org/resources-programs/calm- counseling-access-lethal-means d. Firearm Safety and Injury Prevention. https:// www.acep.org/patient-care/policy-statements/ firearm-safety-and-injury-prevention/
6. Rapid referrals a. HelpPRO Therapist Finder. https://www. onlinetherapy.com/ b. Therapy Finder. https://suicidepreventionlifeline. org/help-yourself/ 7. Discharge planning a. Strategy 4: Care Transitions from Hospital to Home: IDEAL Discharge Planning. https://www.ahrq.gov/sites/default/files/ wysiwyg/professionals/systems/hospital/ engagingfamilies/strategy4/Strat4_Tool_1_ IDEAL_chklst_508.pdf 8. Care transitions a. Continuity of Care for Suicide Prevention and Research. https://sprc.org/wp-content/ uploads/2023/01/ContinuityCare_Suicide_ Prevention_ED.pdf b. Safe Care Transitions for Suicide Prevention. https://dsamh.utah.gov/pdf/ZS%20Docs/ Safe%20Care%20Transitions%20DSAMH%20 2018.pdf 9. Follow-up a. Follow-Up Matters. https://followupmatters. suicidepreventionlifeline.org/#one-month b. Re-engineered Discharge (RED) Toolkit; Tool 5: How to Conduct a Post discharge Follow up Phone Call. https://www.ahrq.gov/patient- safety/settings/hospital/red/toolkit/redtool5. html 10. Caring contacts a. Now Matters Now, Caring Contacts. https:// www.nowmattersnow.org/wp-content/ uploads/2020/04/Caring-Contacts-Text-and- Scripts.pdf b. Zero Suicide, Contact after Leaving Care. https://zerosuicide.edc.org/toolkit-taxonomy/ contact-after-leaving-care
Conclusion
Death by suicide is one of the top ten leading causes of death in the United States for people ages 10-65. 11 Suicidal behavior takes a huge emotional toll on family and friends and an economic toll on society. Therefore, suicide prevention and treatment must be addressed throughout the healthcare community to prevent the further loss of life. Healthcare professionals are in a unique position to prevent suicide due to their frequent contact with patients and should use a multi-factorial approach to screen patients for suicidality to assess their risk level, conduct a thorough assessment, and to appropriately refer patients to appropriate services. Resources Below is an extensive resource list borrowed from the National Action Alliance for Suicide Prevention of suicide-related resources filtered by topic 4 : 1. Suicide Care a. National Action Alliance for Suicide Prevention. This organization lists recommended standard care practices for people with suicide risk. https://theactionalliance.org/sites/default/files/ action_alliance_recommended_standard_care_ final.pdf b. U.S. Department of Veterans Affairs (VA) /U.S. Department of Defense (DoD). The VA and DoD have created their own guidelines for the assessment and management of patients at risk for suicide. https://www.healthquality.va.gov/ guidelines/MH/srb/ c. Zero Suicide. This organization has created a toolkit to help transition individuals through care. https://zerosuicide.edc.org/toolkit/ transition#quicktabs-transition=1 d. Zero Suicide. Universal Health Services Inc, Behavioral Health Division has a detailed suicide care management plan template for inpatient hospital settings. https://zerosuicide.edc. org/sites/default/files/UHS%20Inpatient%20 Suicide%20Care%20Management%20Plan%20 Template.pdf
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