report their concern about the individual to the police, who will conduct a wellness check. While such actions may seem intimidating to many professionals, it’s perfectly acceptable to feel nervous or worried in the process, and it is crucially important to get the high-risk individual help. The alternative of doing or saying nothing, even if no intervention is required in a given profession, is the potential loss of life to death by suicide. While high-risk intervention is intense, it’s also the most extreme scenario and likely to occur rarely in most professional settings. 3. In the case of a non-high-risk case of a suicidal individual needing referral, a professional should have ready the contact information for local mental health evaluation centers, psychiatric hospitals, behavioral health centers, and in more extreme circumstances the local hospital emergency department. In referring a patient for mental health services, it’s helpful to normalize the experience of suicidal ideation and reduce potential concerns about stigma a patient may The collaborative approach A widely used intervention developed by Jobes (2000; 2017) is the Collaborative Assessment and Management of Suicidality (CAMS) approach. CAMS is a “phenomenological” approach, meaning it places an emphasis on what appears to the senses. Jobes was influenced by the work of Shneidman (1999; 2001), who opened the first suicide prevention center in Los Angeles in the 1960s and founded the American Association of Suicidology in 1968. Shneidman developed a theory about suicide that he termed psychache, and many of the areas assessed in the CAMS approach are corollaries to this theory. Shneidman is well known for his development of neologisms (such as “suicidology” and “psychological autopsy”). The following quote from Shneidman underscores his influence on Jobes: Our best route to understanding suicide is not through the study of the structure of the brain, nor the study of social statistics, nor the study of mental diseases, but directly through the study of human emotions described in plain English, in the words of the suicidal person (Cited by Jobes & Mann, 1999, p. 97). The CAMS approach veers away from approaches to intervention that focus on signs and symptoms of depression, and instead devotes more attention to suicidal thoughts, the meaning of the suicidal crisis for the individual, and the client’s views of how suicide represents a solution. CAMS practitioners are interested in psychopathology, but they focus on the “owner of these symptoms” – the suicidal person – and the meaning these problems have for this person. CAMS practitioners also take an explicitly collaborative approach: “When any client acknowledges some degree of current suicidality, the clinician and client proceed to literally and figuratively sit side-by-side to conduct collaboratively an assessment of the client’s suicidality” (Jobes, 2000, p. 13). In the CAMS approach, the client and the therapist independently complete a Suicide Status Form, which ranks the following experiences on a 5-point Likert Scale (Jobes, 2000): Safety planning intervention Originally developed for the U.S. Department of Veterans Affairs, the safety planning intervention (Stanley & Brown, 2008; 2012; 2018) is a brief intervention designed to assist suicidal individuals if a suicidal crisis emerges. It differs dramatically from traditional “no-suicide” contracts in that the safety plan provides information and instruction for suicidal individuals about what to do during a crisis. Conversely, “no-suicide” contracts only state what not to do and have no evidence supporting their use in reducing someone’s suicide risk (Bryan et al., 2017). Safety plans should typically be conducted following a comprehensive suicide risk assessment, utilizing data focused on warning signs, triggers, and protective factors. During the intervention it is recommended that the clinician and patient should sit side by side. All responses should be written in the patient’s own
have. For example, you can say, “It’s very common for people in your situation to experience thoughts about hurting or killing yourself, but people can help with this. You don’t have to suffer all alone.” In addition to providing local treatment information, individuals should also be provided with the phone numbers for any local crisis hotline as well as the national Suicide Crisis Hotline 1-800-273-TALK (8255) . Individuals can also provide website information such as that of the suicide prevention resource council (http://www. sprc.org) or others provided in the Resource Section of the course. Finally, it may be beneficial for the professional to check back with the individual at a subsequent meeting to see if they’ve followed through with obtaining mental health services but attempting to push or pressure the patient may be counterproductive. Your role as a referring professional is simply to ensure the individual has access to the suicide intervention treatment information needed and to continuing being a source of support to the individual.
● Psychological pain. ● External pressures. ● Agitation (emotional upsetness). ● Hopelessness. ● Self-regard. ● Overall risk for suicide.
An item termed Reasons for Living/Reasons for Dying (RL/RD) also is included: On two sets of five blank lines, the client is asked to list separately the reasons for living and dying in order of importance (Jobes & Mann, 1999). In their evaluation of the RL/RD data from clients, Jobes and colleagues (2004) were able to develop consistent categories that could help clinicians identify areas of client concern. Furthermore, responses to the RL/RD provide a window into the client’s internal debate about suicide and thus offer a marker for the client’s motivation toward or away from suicide. Ambivalence is clearly an important hallmark of the suicidal mind, and this simple test is a useful way to approach the subject. The test can have intervention value, “particularly for the cognitively constricted client who is not consciously considering a broader perspective or the full implications of suicide” (Jobes & Mann, 1999, p. 102). The elements considered important in the CAMS therapy approach involve collaborative treatment planning by therapist and client and clinical alliance in treatment. The treatment of an acutely suicidal person is quite simple: It consists, almost by definition, of decreasing or mollifying his level of perturbation. In short, we defuse the situation (like getting the gun), we create activity of support and care around the person, and we make the person’s temporarily unbearable life just enough better so that he or she can stop to think and reconsider. The way to decrease lethality is by dramatically decreasing the felt perturbation (Shneidman, 1999, p. 87). words and be clearly legible. In fact, it is often helpful to have the patients fill out a safety plan template in their own writing. The brief instructions of what to do during a crisis can then be adapted to a format that can be carried at all times. The patient may store the written safety plan in a wallet or purse or keep a photo of the completed safety plan on his or her cellphone. This is particularly helpful for adolescents and young adults, who have their cell phones with them at most times. Stanley and Brown’s brief safety planning intervention, estimated to take 20 to 45 minutes, also provides patients with a prioritized and specific set of coping strategies and sources of support that can be used should suicidal thoughts reemerge. The intent of the safety plan is to help individuals lower their imminent risk for suicidal behavior by consulting a predetermined set of potential
Page 107
Book Code: SWUS1524
EliteLearning.com/Social-Work
Powered by FlippingBook