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SCL1201 - SECTION 6: CONDUCTING A SUICIDE ASSESSMENT: PRACTICE SCENARIOS

Please take some time to read the following scenarios carefully. Questions concerning this scenario will be found on subsequent pages.

Suicide Assessment Scenario 1

James is a 44 year-old Caucasian male police officer. He has come to see you following several big changes in his life. First, he has just received a demotion at work, from Staff Sergeant of first watch, to Beat Officer of the night watch, due to a run in with his superior officer and a number of job performance problems that have been building over the last 8 months. These job performance problems included a suspension for showing up at work intoxicated. Second, he has just been separated from his wife of 16 years, and has had to move back in with his parents, since he cannot afford to pay child support and maintain a residence of his own. His wife has moved to another state with their two children. She has filed a restraining order against him, since he made statements to her with implied threats of violence if she would not allow him to see his kids.

 

Suicide Assessment Scenario 2 

Will A., is a 16 year old adolescent male who will be turning 17 in two weeks, and whose mother has brought him in for oppositional and defiant behaviors, as well as use of marijuana, alcohol, and psychedelic mushrooms pursuant to the death of his father. Will has had a recent history of engaging in extremely risky behaviors, the most severe of which was stealing a car and spending a couple of days in juvenile detention, where he was physically assaulted by another inmate. He has been becoming increasingly sullen and silent at school and home, and has been drawing “tattoos” on his arm with a Swiss Army knife and ink from a ballpoint pen. One of the drawings became infected and led to a trip to the emergency room.  Will tells his clinician that he and his mother are going to be moving to very rural and isolated part of the state in order to be closer to Will’s maternal grandmother, a woman with a history of on again off again alcoholism that has led to repeated conflicts with Will’s mother. During the session, Will tells his counselor that she is the first counselor he has ever trusted, and wishes he could continue the counseling with her, even if it was only “using Skype or something like that.” What risk factors can you identify for this client based upon the information given? What are the factors that would determine if you would consider an involuntary hospitalization for this client? What third parties, if any, do you think may be useful to contact as part of this assessment process? What concerns do you have, if any, about how to approach the topic of suicidality with this client? If suicidality is present, what steps might need to be considered first in stabilizing this client and keeping him safe?

Suicide Assessment Scenario 3

Laura Y. is a mental health clinician specializing in work with adolescent girls. For the past year, she has been working with Natalie M., a sixteen year old with a history of acting out behaviors, self-mutilation and dramatic, but not life threatening, suicidal gestures. Natalie is currently living with her aunt, after a history of domestic violence between her mother and her father escalated to the point where her mother feared for her life and went into hiding, keeping her location hidden from everyone and not having contact with Natalie. Her father also went into hiding to avoid prosecution, but has been seen from time to time by Natalie at her school, where he comes to try to force Natalie to tell her where her mother is living. One afternoon, Natalie calls Laura to tell her that she is pregnant, and she thinks she has been for about a month. In order to avoid the potential repercussions within her family, she ran away with the future father, a seventeen year old boy from her school. After a week on the streets, the boy left her for a former girlfriend who comes from a family with money. Natalie asks for Laura's help in handling the situation, and says she is afraid to show up at Laura’s office because her father might look for her there. What risk factors can you identify for this client based upon the information given? What are the factors that would determine if you would consider an involuntary hospitalization for this client? What third parties, if any, do you think may be useful to contact as part of this assessment process? What concerns do you have, if any, about how to approach the topic of suicidality with this client? If suicidality is present, what steps might need to be considered first in stabilizing this client and keeping her safe?


Based upon the material presented in this training program, take about 10-15 minutes to plan and prepare how you would conduct a suicide assessment for the clients presented in these scenarios. Give some thought to the risk factors you would look for, and which questions you would emphasize in a client interview.

In order to help organize your thinking in this exercise, we will present some questions for you to consider on the following page.

Question 1: What risk factors can you identify for this client based upon the information given?

Question 2: What third parties, if any, do you think may be useful to contact as part of this assessment process?

Question 3: What concerns do you have, if any, about how to approach the topic of suicidality with this client?

Question 4: If suicidality is present, what steps might need to be considered first in stabilizing this client and keeping him safe?

Take your time in preparing your answers to these questions, then compare them with the analysis on the pages to follow.


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