Suicide Prevention and Intervention Skills
It's verbal, not written? The suicide contract or agreement itself is verbal. It's best to have it in writing to cover yourself legally. Even if you make the agreement verbally it's important that in your client's file you write down exactly what you did, including the questions you asked in assessing suicide, the responses, and the verbal suicide contract. Date it and sign it. Now I also explain along with that verbal contract that it's not good enough just to leave a message on my answering machine, and if I can't be reached the agreement is that you won't follow through on any ideas of committing suicide until you talk to me personally. Alternatives in the agreement are that he will go to hospital or phone a Distress Line.
If I couldn't get that agreement from a client, which would be rare, I wouldn't be able to work with that client. I would have to refer him to another service. I do not tell him that if he doesn't agree to it, that they will be referred to someone else. So who do you refer him to? You've got somebody who is ready to jump off the bridge, but he won't agree to the contract. If he said that he is going to jump and won't go to hospital, I'll involve the police for intervention.
If he just has suicidal ideas and is not willing to make the contract, I would see him as a highly manipulative client. I wouldn't be able to work with that person anyway. I'd recommend he approach his family doctor for a referral to a psychiatrist. Do you ever get a client just using suicide as an excuse to call you about any other area that he has difficulty with? If he makes a statement that he is going to commit suicide or feels suicidal, I'll take it at face value. How do you know what his final intention will be? Even if it's a manipulative way of getting attention, I will still see him as feeling desperate and treat it as a serious intention.
Before involving family it is very critical to assess how much support is there. If we see that the family is not caring and not being very supportive then we'll have to make appropriate arrangements. It's not always easy for the family. An example is the person who was very depressed, and talked a lot about suicide. Her family was very supportive, and loving, and understanding, and she got through her depression. Three years later she became depressed, and her family was worried that this was happening all over again. They talked to her and she said, "Oh no, everything is fine," and a few days later she took her own life. Was there some element missing, some reason they weren't enough of a support system for her? But if a person is intent on suicide and plans carefully, maybe there is nothing anyone can do to stop it.
If I couldn't get that agreement from a client, which would be rare, I wouldn't be able to work with that client. I would have to refer him to another service. I do not tell him that if he doesn't agree to it, that they will be referred to someone else. So who do you refer him to? You've got somebody who is ready to jump off the bridge, but he won't agree to the contract. If he said that he is going to jump and won't go to hospital, I'll involve the police for intervention.
If he just has suicidal ideas and is not willing to make the contract, I would see him as a highly manipulative client. I wouldn't be able to work with that person anyway. I'd recommend he approach his family doctor for a referral to a psychiatrist. Do you ever get a client just using suicide as an excuse to call you about any other area that he has difficulty with? If he makes a statement that he is going to commit suicide or feels suicidal, I'll take it at face value. How do you know what his final intention will be? Even if it's a manipulative way of getting attention, I will still see him as feeling desperate and treat it as a serious intention.
Before involving family it is very critical to assess how much support is there. If we see that the family is not caring and not being very supportive then we'll have to make appropriate arrangements. It's not always easy for the family. An example is the person who was very depressed, and talked a lot about suicide. Her family was very supportive, and loving, and understanding, and she got through her depression. Three years later she became depressed, and her family was worried that this was happening all over again. They talked to her and she said, "Oh no, everything is fine," and a few days later she took her own life. Was there some element missing, some reason they weren't enough of a support system for her? But if a person is intent on suicide and plans carefully, maybe there is nothing anyone can do to stop it.
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