Duty of Care in Suicide Prevention

Mode
Balance Type
Counselling
Category
Procedure
Balance for
Mode Category

Suicide Prevention Summary

Chinese sign for Crisis = Danger + opportunityQ – What feelings might you feel if a client talks about suicide?

  • Eg responsible, incompetent, fearful, anxious, overwhelmed, out of control

Q – What can you do to help yourself?

  • Panic – How do we recognize in ourselves?
  • Accept your own fear and have the courage to address the issue
  • Relax and stay calm, centered with client
  • Recognise limits
  • Don’t assume total responsibility for the situation
  • Know what resources are available
  • Have a framework to guide you
  • Have clinical supervision available afterwards for debriefing

Q – How can we help the client?

  • Don’t avoid the issue
  • Be direct, not tentative. This de-stigmatises and normalises the feelings. It will not increase the risk of suicide. Think of suicide risk like a pressure cooker – your job is to help release pressure.
  • Further normalise the feelings they have through your reactions and responses
  • Ask about specifics – plans, attempts, what triggered, what stopped them.
  • Express your own concerns about the risk and explain strategy with them
  • Ask them to make a no harm agreement or contract with you
  • Be yourself and focus on the relationship – listening, compassion, presence
  • Trust that they want to live

Q – Why might clients not want to talk about it?

  • Eg stigma, feelings of failure, need for support & loss of independence

Q – How do we assess risk?

  • Suicide risk checklist
  • Females more likely to self-harm
  • Males more likely than females to suicide – why? o Less likely to talk about feelings
    • Lethality of method
  • Older men most at risk (75 and above), then 25-45 years next
  • Other risk factors
    • Indigenous
    • Mental illness
    • Rural, isolated (also rural – more exposure to lethal methods)
    • Young LGBT
    • Lower socio-economic status
    • Family issues – abuse, alcoholism etc
    • Bereaved through suicide

Duty of Care in Suicide Prevention

  1. Assess risk – if client safety in doubt, implement plan.
  2. Consider level of risk and own confidence in continuing with client professionally. If risk medium or higher, referral to clinical psychologist is strongly recommended (may be in conjunction with you).
  3. Consider no harm agreement (see Procedures section).
  4. Low risk - request client contact support network person to collect them from clinic (or call them yourself). Explain situation to support person.
  5. Moderate risk – contact support person (if reliable) to collect, explain person should not be left alone and provide resources for ongoing support (local mental health unit, Lifeline)
  6. High risk – call support person AND Lifeline or Mental Health Unit
  7. If no one available, call Lifeline or local Mental Health Acute care unit.
  8. If client leaves without support against your advice, call Police.