Here are some risk factors and warning signs for suicide.
Pic 11: The screen changes to a slide titled “Suicide Warning Signs” with a caution symbol next to it. It contains the following list:
Pic 12: The screen transitions to a close-up of Dr. Eber. A text box with the title “Risk Factors and Warning Signs” with a caution symbol appears next to her. It contains a list, and each item has a check mark in front of it.
If you recognize risk factors and warning signs, again, you can ask the client if she’s having thoughts of suicide. You can also follow up with a screening tool, like the PHQ-9 or C-SSRS, to help determine the level of risk specifically related to manifestations of depression.
Pic 13: The camera returns to the wide shot of Austin and Dr. Eber at the table.
Austin: Once we have some idea of the client’s risk level, what do we do next?
Dr. Eber: Well, clients may need a referral for mental health services or medication, or both.
Pic 14: The screen transitions to a close-up of Dr. Eber. A text box appears with the title “Actively Suicidal and an Imminent Threat” with text underneath that reads “Arrange for voluntary hospital admittance or Take steps for involuntary hospital admittance as a last resort.” Each option has a check next to it.
If the client is actively suicidal and you and the provider believe they are an imminent threat to themselves, you’ll need to take immediate action. You can assist the provider to arrange for them to be admitted to the hospital voluntarily, or steps may need to be taken to have them admitted involuntarily, which could require you to call 911.
Pic 15: The text box disappears and is replaced with one titled “Lower Level Risk,” and the text underneath has a check mark next to it and reads “Work with client on a safety plan.”
If the client’s risk level is lower, you should work with them to develop a plan for what to do to stay safe when suicidal thoughts surface in the future.
Pic 16: The screen transitions to a slide titled “Safety Planning” and subtitled “Triggers” with an image of a caution symbol.
Help clients identify triggers for suicidal crisis. For example, they might say they think about suicide more when they are drinking. Being aware of this can help them plan for these feelings in advance.
Pic 17: This slide is subtitled “Coping Strategies” and has an image of a figure running on a treadmill.
Ask what coping strategies have worked for them in the past, like relaxation techniques or exercise.
Pic 18: This slide is subtitled “Sources of Support” and has an image of one central figure connected to an array of others.
Help them identify friends and family who can help them during a crisis. Identify health professionals or agencies to contact in the event of a crisis, such as the National Suicide Prevention Lifeline (1-800-273-TALK).
Pic 19: This slide is subtitled “Access to Lethal Means” with an image of a gun.
If they have access to lethal means they may use in a suicidal crisis, talk about how to keep safe. For example, they may choose to lock up or throw away substances, like opioids. They may ask a friend to keep their gun or they might put it in a lock box in a difficult to reach place. Increasing the time for them to access lethal means decreases the chances of acting on impulse.
Pic 20: The screen returns to Dr. Eber and Austin at the table.
Dr. Eber: Now it’s time for you to speak with Judith. In this conversation, your goal is to gather information about her presenting concern, as well as her depression manifestations. Then, together, you’ll work towards a treatment plan.
Austin: Okay. (seems a bit uneasy)
Pic 21: The camera transitions to a close-up of Dr. Eber.
Dr. Eber: I know you probably don’t have conversations like this very often, and it’s normal if you feel a little uncomfortable. Even so, make sure you keep a calm and direct tone, so the client doesn’t get alarmed or feel alienated.
Pic 22: The camera changes to a close-up of Austin.
Austin: Right. Okay, let’s do it.
Pic 23: The screen transitions to the image of a Patient History and Physical document for Judith which includes a picture of her, with the following information:
Name: Judith Meyers
Age: 66
Chief complaint: Worsening wrist pain and headaches
History of present illness: Wrist pain from arthritis has intensified recently. Notes new and worsening headaches (top of head) that come and go. No photophobia or phonophobia, visual disturbances or loss of balance. No vomiting or other GI symptoms.
Medical history:
Surgical history: Laparoscopic hernia repair
Family history:
Family: Mother deceased (hypertension and coronary artery disease), father deceased (hypertension, hyperlipidemia, stroke). Husband and daughter. No siblings. No tobacco, alcohol, recreational drugs.
Allergies: Penicillin, mild rash.
Medication: Ibuprofen 400mg Q6 hours PRN