As counselors, we all have encountered suicidal clients at one time or another. Today I had an emergency client who was suicidal. She talked her heart out and I gathered from her story that she just wanted things to go her way, she didn't really want to die. She has been self-injuring for most of her life and finds that this helps her numb the painful feelings. She has minimal support so a case manager was suggested to help out with all the overwhelming things she has to do. She has children that don't listen to her and anything that was suggested she said she tried already and is tired of trying now.
I took her suicidal thoughts seriously and assessed risk, she wants to go back in the hospital but has school and doesn't want to miss school either. It's a Russian roulette when dealing with suicidal clients. My one colleague mentioned to me that he doesn't want anything to do with suicidal clients because he doesn't want a suicide on his record. That got me thinking that ANY ONE of our clients even those that seem stable can kill themselves and we should assess each client every time they come to see us, a truly suicidal client may never be suspected of being suicidal because they don't want anyone to know. The others that confess they have suicidal thoughts want help.
I am not afraid of having suicidal clients on my case load, I value their lives and anything I can do to help them is rewarding. Sometimes all they need is someone to help them think clearly, listen to them without judging and take them seriously. It is important to feel confident in your risk assessment and know when to hospitalize; however everyone with suicidal ideation does not need hospitalized.
A brief suicide risk assessment includes: 1) Has the client made previous suicide attempts? 2) How intense is the commitment to suicide? 3) How stable is the client's mental status? 4) How supportive is the client's environment? 5) How good is your treatment alliance? and 6) What is the plan for reducing the present suicide risk? Are the client and other participants willing and able to follow the plan? (Mays, 2009).
It is my hope in writing this blog that counselors will feel more confident in working with suicidal clients, understand the suicidal clients and make a good risk assessment and plan for the client to follow. My agency has a standardized crisis intervention plan and every suicidal client is to sign it and understand the plan to follow. I encourage my clients to call me if they are feeling suicidal and I can do a risk assessment over the phone and then have them come in for an appointment that day or the next.
Kimberly Beck is a counselor and a doctoral candidate with a special interest in Self-injury. Other interests are PTSD, trauma, and Borderline personality disorder