He admits to current suicidal ideation and intent at this time. He says he could not commit to his safety and rated the strength of his intention to kill himself an 8 on a scale of 0 to 10. Mr. Moore appears to be at high risk for suicide given his current crisis, lack of support, and history of multiple attempts. He seems to have recently moved down the pathway to preparation for suicide. He has access to lethal means. Mr. Moore indicates that he does not want to be hospitalized due to his fear of the consequences of absence from work. Although inpatient hospitalization would disrupt his work schedule, his danger to self outweighs this concern. The next lower level of care, partial hospitalization, would have the advantage of allowing him to stay at home in the evening, but would still disrupt his work schedule and would also appear to be inadequate in providing the protection he needs at this time. Continuing outpatient therapy, or even increasing his outpatient contact to daily, might help circumvent his work concerns. This, too, would obviously be less than the structured intervention he now seems to require. The recommendation of inpatient treatment was not welcomed by Mr. Moore. It was explained that this
assessor was prepared to contact the authorities if Mr. Moore declined to be evaluated at the hospital. Mr. Moore indicated that he would rather “choose” going to the hospital over having the courts or police involved. The results and recommendations of this evaluation were shared with both the referring therapist and this evaluator’s supervisor; both were in agreement. The client was escorted under constant observation to the hospital assessment center. A copy of this note was provided to staff there. This note covers the risk factors and recent and past suicide behaviors, summarizes a mental status examination, and provides a risk/benefit consideration of the various courses of action. The note provides a “thinking out loud” approach to the reasons for the clinical decision. Joiner and colleagues suggest the following documentation if using their risk assessment: Suicide risk was assessed according to standard protocols (Chu et al., 2015) and determined to be [low/moderate/ severe/extreme] due to … [e.g., ideation, plans, preparations, etc.]. Action taken: [e.g., safety plan, emergency numbers, consulted with supervisor, etc.]. Risk will continue to be monitored (Chu et al., 2015, p. 1200).
CONCLUSION
One of the most serious mental health issues that clinicians face in their work is dealing with individuals who are expressing suicidal intent. It is the clinician’s responsibility to complete a thorough assessment of the risk factors expressed by all clients as they describe their thoughts, emotions, and behaviors. As the clinician collects this information, he or she is faced with the daunting task of determining the imminent risk for the client to attempt and perhaps complete a suicidal act. This
course has provided information to assist clinicians to complete an assessment that will lead to better outcomes for clients. A thorough assessment that leads to a well-conceived intervention plan is the goal for both client and therapist. Of course, the clinician must also provide adequate documentation that a thoughtful and professional process has been followed in completing the assessment and intervention plan.
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