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Suicide Ideation and plan vs no Plan

Suicide Ideation and plan vs no Plan. Aka: Do I take this serious? Dr Lisa Arieta Hayes. California State Law. We are required to report suspected: Physical abuse Sexual abuse Serious neglect Suicidal ideation with intent Homicidal ideation with intent. Risk Assessment for suicide.

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Suicide Ideation and plan vs no Plan

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  1. Suicide Ideation and plan vs no Plan Aka: Do I take this serious? Dr Lisa Arieta Hayes

  2. California State Law • We are required to report suspected: • Physical abuse • Sexual abuse • Serious neglect • Suicidal ideation with intent • Homicidal ideation with intent

  3. Risk Assessment for suicide • Age • Sex • Stress • Symptoms • Prior Suicidal behavior • Current degree of planning • Resources

  4. Suicide Risk by Age and Gender in California • Female Youth • Most at risk ages 15-19 • Male Youth • Most at risk ages 20-24 • Female Adults • Ages 50-59 • Male Adults • Ages 70 years and above

  5. Clues to Suicide • Helpless/hopeless • Anger or fighting • Insomnia or hypersomnia • Self inflicted injuries • Giving away belongings • Developing will and/or saying goodbye • Making threats to kill self/others

  6. More Clues • Unrealistic guilt • Isolating from friends and family • Resentment and hate • Increased alcohol and drug abuse • Poor appetite or overeating • Poor self care and hygiene • Crying • Poor health

  7. Suicide Assessment • Intent • The client makes verbal statements • “I wish I was dead” • “I want to die” • “I’m gonna kill myself! • The client has thoughts • “I can’t go on” • “I’m in too much pain but I can’t tell anyone” • Passive intent – no real plan • “I want to die but haven’t thought how I would do it” • “I just wish a car would hit me” • “I wish I just wouldn’t wake up” • Clue is person has No Active Plan

  8. Assessment • Plan • Time line of when • E.g. anniversary of husband’s death • How • Pills, gun, hanging etc… • Where • At home after everyone leaves • The client shares a clear plan then 5150 • The client has no plan – then no harm contract and constant monitoring • Check in each time you see them and renew each week

  9. Assessment • Lethality • Method will likely result in death • Has easy access to the method • In possession of the method • Not lethal e.g. jump out of plane, take birth control pills • History of previous attempts • Must get details of each attempt and what happened e.g. took bottle of aspirin, hospitalized, stomach pumped • No as serious attempts e.g. superficial cuts; taking medication that is not lethal or not taking enough e.g. took 2 valium

  10. Assessment • Contracting • Contracts does not mean a client will not commit suicide • Even is a client signs a contract it does not mean that they will not change their mind • Contracts represent good faith effort and agreement of client with you to work together on this problem • Important to have with clients who have no plan but often has thoughts of suicide/death

  11. Contract • Includes agreement not to harm self • Promises not to harm self unless contact therapist, crisis/suicide hotline, or agency’s 24 hour answering services first • Time limited • Reviewed and documented constantly • Agencies usually have boiler plates to use – ask your supervisor for a copy or where to find on agency shared drive

  12. So What do I do?? • Find out protocol for your agency • Seek out policy and procedure with supervisor • Review no harm contract • Seek out supervision IMMEDIATELY when you have any questions regarding suicide

  13. Questions?

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