Wasson_suicideinterventionplan

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1 Suicide Intervention Plan Suicide Intervention Plan Brittany Wasson School of Behavioral Sciences, Liberty University Author Note I have no known conflict of interest to disclose. Correspondence concerning this article should be addressed to Brittany Wasson Email: bnwasson@liberty.edu

2 Suicide Intervention Plan Presenting Problem The presenting problem in the case of Joanne, a 45-year-old-female, with history of depression and previous suicide attempts is that the client has shown up unexpectedly at the outpatient clinical counseling office to inform the counselor of her appreciation for her and the importance we have in her life. When questioning the client, she discloses that she has a gun in her vehicle. The counselor asks the client to stay and talk, but Joanne refuses and states that she “just wants to go for a drive.” The client’s history of depression, noncompliance to taking her prescribed medication and previous suicide attempts are concerning with the behavior she is presenting at the office. The immediate crisis is that she has a weapon in the car and has no desire to speak with the counselor and just wants to be alone to drive. Because of the client’s significant medical history and stressful life events, there is a possibility of reoccurring suicidal behavior. According to SAMHSA’s Quick Guide for Clinicians (2013), prior history of suicide attempts, co-occurring mental disorder such as depression, conflicted relationships, access to firearms, and stressful life circumstances are all risk factors that the client currently has. Precipitating Event Joanne has dealt with several issues in her life, leading up to this current situation. Joanne has had a prolonged history of depression. She is a 45-year-old divorced female who has suffered greatly from her depression. She has had multiple suicide attempts in the past, which she has attempted by overdosing and cutting her wrists. Her life consists of many stressors such as a demanding job with long hours, which is where she gets her gratification from as she has no hobbies or other things she enjoys. Joanne has been involved with complicated situations which can have an impact on her mental health. She divorced from her husband 10 years ago, who admitted that he was gay, she

3 Suicide Intervention Plan has not dated since. After her divorce, seven years ago, she began an affair with her sister’s husband. Although Joanne ended the affair due to feelings of guilt, her sister’s husband still tries to pursue her. Risk Factors  History of depression  Divorced  Prior suicidal ideation  Refusal of prescribed medication  Stressful work life (long hours)  Access to firearm  Lack of hobbies  Feelings of guilt  Affair  Lack of social interaction/lives alone Joanne is displaying many psychosocial factors that are associated with suicide risk according to the U.S. Department of Veterans Affairs (2023). These factors are recent losses, in Joanne’s situation, the loss of her marriage. Long-term problems such as relationship difficulties, her divorce and the affair with her sister’s husband. Psychological states of acute or extreme distress, feeling of guilt due to the affair. These factors can lead to suicidal ideation or suicidal behavior. Resources and Protective Factors Joanne is a white, middle-class female and lives in an area with plenty of resources available to her. She has no issues with health coverage due to receiving it through her full-time

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4 Suicide Intervention Plan job, she is currently utilizing this to seek treatment with her psychiatrist. She sees her psychiatrist monthly and is a stable resource for her to seek care. The client should be informed on helpful resources such as the suicide hotline and the National Alliance on Mental Illness (NAMI). The hotline will provide Joanne with someone she can speak with about the difficulties she may be facing, especially if she is unable to get in contact with her psychiatrist or counselor. NAMI provides many resources such as videos, articles and blogs to help all areas of difficulty. Studies have shown that crisis lines and online resources can reduce psychological distress and de-escalate individuals in a mental health crisis (Hoffberg, et al., 2020). While Joanne does not have any hobbies or social network, she has a 13-year-old daughter who relies on her for support and to be a positive and healthy role-model. Her daughter can provide her with the feeling of belonging and reason to keep moving forward. Joanne’s daughter is a major protective factor in her life that can give her strength and the will to survive her difficulties. Due to her lack of social network, Joanne spends a lot of time at work and can possibly confide in her coworkers during times of need. The community that Joanne lives in also provides resources for those who are struggling with depression and suicidal ideation. The local churches and mental health centers provide weekly, in-person meetings and social gatherings for those suffering from mental stress and suicide. These groups help those struggling with similar issues feel like they belong and have people to relate to and have shown to be a valuable asset for the mental health community (Lehmann, et al., 2022). Unfortunately, there may be challenges for Joanne when seeking out these resources or support. She has self-isolated and only wants to involve herself in work and has also stopped taking her medication. With her only motivation being work, it may be difficult to get her to

5 Suicide Intervention Plan speak to anyone other than her psychiatrist, which she may now be afraid to speak to because of her negligence with her medication. Spirituality Ethical Considerations When working with clients, especially those that are high-risk, it is important to consider their spiritual beliefs, if they are known. As a counselor, it is also crucial that these considerations are ethical and do not cause further discontent to the client. The AACC Code of Ethics states that we must consider cultural, ethnic and racial diversity that influence a client’s spiritual beliefs. We must not impose our values onto clients and remain competent in order to understand the client’s belief system. No matter their beliefs, services must still be rendered without passing judgment onto the client (AACC, 2014). The ACA Code of Ethics A.1.d.(2014) states that counselors must recognize that the client may have a variety of support networks that they utilize, which may be spiritual or religious. It is important that counselors understand these support systems and incorporate them into the client’s available resources, as long as the client consents. Spiritual Considerations Spiritual considerations for high-risk client’s like Joanne may be crucial due to her lack of social support, this may be a meaningful support system for her. Counselors must also remain competent and not discriminate against a client’s spiritual or religious beliefs and understand the diversity that exists with each client (ACA, 2014). Jackson-Cherry and Erford (2018) explain the importance of spiritual and multicultural considerations with clients. In a life crisis situation, personal religious beliefs should be explored, while being cautious of the client’s reaction, in

6 Suicide Intervention Plan order to meet their needs. The counselor should always keep their values and beliefs from conflicting with the client and creating further distress. Interventions  Gather information and conduct a triage assessment- (Is Joanne safe? Is she thinking of harming herself or others?) -Involve emergency personnel when necessary  Encourage Joanne to speak up about her emotions and feelings currently to calm Joanne and help encourage her to not leave the office -Active listening, validate feelings and emotions, express empathy  Contact Family support system with client’s consent  Consult with colleagues for support due to the severity of the situation  Contact Joanne’s psychiatrist to coordinate treatment  Provide Joanne with resources due to her lack of support  Encourage a follow-up/ongoing treatment when stabilized Treatment Plan: Goals and Interventions Problem 1 (mental) : Joanne is suffering from depression Goal 1: Reduce depressive symptoms Objective 1: Joanne will work to verbally identify the source of the depressed mood (Kolski, et al., 2014) Intervention 1: Counselor will provide a comfortable, empathetic, and non-judgmental environment where Joanne will continuously want to express her feelings that contribute to her depressed moods 2x per week for 6weeks. Work to clarify these thoughts and feelings and gain an insight to

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7 Suicide Intervention Plan what is causing her to feel this way and reassess after 6weeks (Kolski, et al., 2014). Problem 2 (physical) : Joanne works stressful job, 60-70 hours a week Goal 1: Prioritize self-care and limit time spent at work Objective 1: Joanne will practice ways to relax and pursue activities that used to bring her joy/spend more time with family (her daughter). Intervention 1: The counselor will encourage Joanne to prioritize her self-care and family time work to reduce the amount of stress she is being burdened with. Joanne and the counselor will establish a self-care plan that will work with the client’s schedule (shorten work hours if possible). The counselor and Joanne will work on developing and executing this plan 1x per week for 6weeks. Reassess Joanne’s stress levels in 6weeks. Problem 3 (emotional) : Joanne has attempted suicide three times Goal 1: Strengthen Joanne’s interest in life Objective 1: Joanne will identify activities, beliefs, items or people in her life that give her strength. Intervention 1: The counselor will facilitate a discussion with Joanne to discuss her core values and individuals who give her life meaning. Joanne will then reflect these areas to the counselor and help form an emotional connection to what truly matters in her life. These areas will be discussed 1x a week for 4weeks, with reassessment at 4 weeks to track progress. Problem 4 (social) : Joanne has no hobbies or social network

8 Suicide Intervention Plan Goal 1: Discover enjoyable hobbies and build healthy social relationships Objective 1: Identify hobbies Joanne enjoyed in the past and individuals she had a friendly connection with Intervention 1: The counselor will provide Joanne with a worksheet that will be completed at home. This worksheet will be a diagram consisting of Joanne in the middle, individuals she had a friendly connection with on the left and hobbies on the right. The client will be seen again in 2 weeks to discuss these areas and work to develop a hobby schedule and scheduling activities with these individuals that will take place over the course of 8weeks total. Problem 5 (spiritual) : Joanne has not identified any spiritual support or interest Goal 1: Joanne will find a spiritual connection as a means of support Objective 1: The client will explore and clarify her feelings on a spiritual belief Intervention 1: The counselor will work with Joanne to explore the client’s beliefs and what they believe could help guide them through both peaceful times and hardships they may face. Joanne will identify spiritual individuals that she feels most connected with and will meet with us 1x per week for 6weeks to help build a spiritual foundation.

9 Suicide Intervention Plan References American Association of Christian Counselors (AACC). (2014). AACC code of ethics. Y-2014 Code of Ethics. American Association (aacc.net) American Counseling Association. (2014). 2014 ACA code of ethics. https://www.counseling.org/docs/default-source/default-document-library/2014-code- of-ethics-finaladdress.pdf Hoffberg, A. S., Stearns-Yoder, K. A., & Brenner, L. A. (2020). The Effectiveness of Crisis Line Services: A Systematic Review. Frontiers in public health , 7 , 399. https://doi.org/10.3389/fpubh.2019.00399 Jackson-Cherry, L.R. & Erford, B. T. (2018). Crisis assessment, intervention, and prevention (3rd ed.). Upper Saddle River, NJ: Pearson. Kolski, Jongsma, A. E., & Myer, R. (2014). The crisis counseling and traumatic events treatment planner with DSM-5 updates (Second edition.). Wiley. Lehmann, C.S., Whitney, W.B., Un, J. et al. Hospitality Towards People with Mental Illness in the Church: a Cross-cultural Qualitative Study. Pastoral Psychol 71 , 1–27 (2022). https://doi.org/10.1007/s11089-021-00982-1 Quick Guide - SAMHSA Publications and Digital Products. (2013). https://store.samhsa.gov/sites/default/files/d7/priv/sma13-4793.pdf U.S. Department of Veterans Affairs. Suicide risk assessment guide: reference manual. (2023). Suicide Risk Assessment Guide: Reference Manual (va.gov)

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