SCENE 15 Suicide risk assessment

Summary

In this video, we focus on a crucial yet sensitive subject: suicide risk assessment. The conversation centers around Ian, who is grappling with depression, hopelessness, and recurrent suicidal thoughts. Despite these feelings, Ian is hesitant to act on his thoughts due to considerations for his daughter and religious beliefs. The discussion emphasizes the importance of thoroughly assessing risk factors such as intent, means, and support systems, while also highlighting the need for empathy and patience in these delicate situations. By exploring Ian's story, viewers gain insights into the complex nature of suicide risk assessment and the pivotal role of protective factors in preventing suicide.

Highlights

• Ian feels overwhelmed by a negative work review, exacerbating his depression. 😔
• He admits to having frequent suicidal thoughts yet struggles with acting on them. 😟
• Protective factors include concern for his daughter and religious upbringing. 🕊️
• Engagement with family is suggested as a potential support to combat loneliness. 📞
• Thorough suicide risk assessments involve exploring intent, means, and immediacy. 🧠
• Empathy and patience are keys to effective suicide risk discussions. 💬

Key Takeaways

• Suicidal thoughts often stem from overwhelming circumstances, making empathy crucial. 🤗
• Assessing risk involves understanding the client's intent, means, and history. 🔍
• Protective factors like family and beliefs can deter suicidal actions. 🛡️
• Conversations need sufficient time—rushed assessments risk missing critical information. ⏳
• Supporting clients in finding hope and engaging with supportive circles is vital. 🌟

Overview

Ian's week hasn't been easy, and things took a downward turn after a rough meeting with his boss about his work performance. His inability to focus exacerbates his depression, making him feel overwhelmed and unclear about handling the mounting pressures. Despite this, protective factors like his daughter and religious beliefs hold him back from rash decisions.

The conversation with Ian reveals key insights into his state of mind. Although overwhelmed with despair and frequent suicidal thoughts, Ian struggles with the idea of leaving his daughter behind. He contemplates using his medication to end his life but admits the thought clashes with his beliefs, leaving him torn.

The therapist's approach highlights the complexities in suicide risk assessment. It requires exploring the seriousness of Ian’s intentions, available means, and his immediate support network. Notably, the therapist encourages Ian to reconnect with his brother, a potential support outlet, while emphasizing the balance between empathetically listening and gently encouraging action towards hope.

Chapters

• 00:00 - 00:30: Introduction and Recent Events The chapter "Introduction and Recent Events" begins with a conversation highlighting a rough week experienced by the character Yan. Yan recounts a recent meeting with their boss, which focused on their work performance, adding to the difficulties they've been facing.
• 00:30 - 01:00: Feeling Overwhelmed and Helplessness The chapter titled 'Feeling Overwhelmed and Helplessness' discusses the impact of depression on an individual's work performance and concentration. The main character feels judged by a negative performance review at work, adding to feelings of overwhelming stress. The chapter highlights how the character struggles to manage work responsibilities amidst personal challenges, leading to a sense of helplessness. The emotional burden of these experiences compounds, illustrating how mental health issues can significantly interfere with professional and personal aspects of life.
• 01:00 - 02:30: Contemplating Suicide The chapter delves into intense feelings of being overwhelmed experienced by an individual who is contemplating suicide. The conversation explores the mental exhaustions and the sense of losing control as one problem compounds upon another, leaving the individual feeling unable to cope with the situation. This captures the depth of emotional distress and the pressing need for understanding and support.
• 02:30 - 04:00: Protective Factors and Support This chapter explores the challenges faced by individuals experiencing difficulty in seeing improvements in their life situations. It highlights how financial struggles and workplace issues can exacerbate feelings of depression and concentration problems, making it hard for individuals to envision a better future. The narrative captures the sentiment of hopelessness and the struggle to find worth in current circumstances.
• 04:00 - 06:00: Therapist's Concern and Support Options The chapter titled "Therapist's Concern and Support Options" revolves around the mental struggle of an individual who feels stuck in a 'rut'. The individual expresses feelings of helplessness and frequently contemplates suicide. This concern has been particularly prominent over the past few days and has been a significant issue since the latest review of their situation.
• 06:00 - 08:30: Ian's Actions and Challenges In the chapter titled 'Ian's Actions and Challenges,' Ian talks about the recurring thoughts that occupy his mind. He admits that these thoughts are almost always present, indicating they are a significant burden to him. Although Ian doesn’t elaborate fully on the nature of these thoughts, he hints at a desire for simplification or relief from the complexity they bring to his life.
• 08:30 - 10:30: Therapist's Observations and Risk Assessment In this chapter, the therapist discusses the potential for the client to 'bow out,' or step back, from a situation. The therapist acknowledges the difficulty in discussing this topic, encouraging the client to take their time. The chapter focuses on assessing the risks and implications of the client's decision, allowing them space to reflect on their feelings and potential actions.
• 10:30 - 14:00: Risk Assessment Details and Strategies The chapter focuses on risk assessment strategies, particularly concerning the potential misuse of medication prescribed by a general practitioner (GP). It explores thoughts of medication overdose as a means to end life and the factors that hold an individual back from acting on such thoughts. The dialogue suggests a scenario where the person is contemplating the amount of medication needed and reflects on what has prevented them from following through with those thoughts so far. This indicates a need for a deeper understanding and intervention strategies to prevent self-harm.

SCENE 15 Suicide risk assessment Transcription

• 00:00 - 00:30 okay Yan so you've been telling me that you've actually had quite a a rough week this week can you tell me a bit more about what's been going on for you um things were things were bad as you know last time I saw you but I had a a meeting with my boss right this week and um it was about my work performance um and I I think that my
• 00:30 - 01:00 depression's been getting in the way of you working properly at work as well haven't been able to concentrate and so on so he um didn't really think that I'd been performing too well um so my review was quite bad in a number of areas and I don't know I just I just feel as though it's just another thing that I don't really need to deal with at the moment on top of everything else okay so it's leaving you
• 01:00 - 01:30 feeling quite overwhelmed yeah overwhelmed and just just don't know if I can handle it anymore okay when you say that you don't feel that you can handle it what kind of goes through your mind thinking about that it's it's just one thing on top of another on top of another and no matter what I do I just just you know I can't
• 01:30 - 02:00 seem to see how things are ever going to get any better mhm MH so it's very very hard with all of this happening with your financial problems within having the the you know having difficulty at work because you're feeling so depressed with your concentration to ever even think that things might get better okay does that kind of make you feel that it's kind of not worth it at the moment yeah I just I don't think that
• 02:00 - 02:30 anything I can do is going to help me get out of this okay rut so feeling quite helpless okay does that make you think at all about wanting to end your life it does how often is that coming up for you quite yeah a lot in the last since the review last few days last few days
• 02:30 - 03:00 okay so you you having those kind of thoughts going through your mind do you have anytime when they're not going through your mind not much not much okay so so tell me a bit more about what actually goes through your mind when you think about this just I think it just be a lot easier just to
• 03:00 - 03:30 bow out M so that that seems like kind of an option that that would work okay have you thought about how you might do it if you were to bow out yeah okay sorry it's a little bit hard to talk about mhm take your time
• 03:30 - 04:00 probably you know with the medication that my GPS put me on right and I don't know much about it but i' imagine if I took enough it would be enough okay so when you think about it you think well if I took all the medication that I have then then maybe that would be enough to to end my life I think so okay and um you know you you're obviously here today so what is stop you so far from
• 04:00 - 04:30 actually acting on those thoughts not much um I don't know I I don't like the idea of my daughter thinking MH that I didn't have the guts to stick with my life mhm okay so so that's something that kind of stops you when you think think about her a bit Yeah a bit any other
• 04:30 - 05:00 things I'm from a fairly religious background I suppose and does that feel for you that kind of are stopping you from so far from having kind of done it okay and are you aware Ian of kind of what you're hoping will happen cuz sometimes I know when we feeling this desperate and we feeling
• 05:00 - 05:30 very very overwhelmed we can get a sense of we just want things to stop versus maybe wanting to kind of to die so I'm just trying to understand what it feels like for you I just want it to stop you want it to stop okay so it seems that saying taking all the pills that you have would be one way of having a solution to your problems okay but when you think about that what's stops you from actually
• 05:30 - 06:00 doing anything is the feeling of you know what your daughter would feel like if you did it and also that it kind of goes against your beliefs okay but it must seem quite quite overwhelming to have those thoughts then yeah just seems like the only the only way the only way okay so has it been quite hard for you in the last while as well the last week since you had the performance you to focus on
• 06:00 - 06:30 the things that we've been talking about in terms of the things looking at strategies that may help you to start to feel better yeah I'm sorry I haven't really given that much thought okay so that's been really really hard to hold on to okay so I just want to kind of check what have you have you still been going to work since the performance review what have you been doing
• 06:30 - 07:00 spending a lot of time in bed right just sitting around the house mhm looking at photographs this is off your my Bo yeah and the more you do that does it make you feel worse okay
• 07:00 - 07:30 so it would seem that we're in a a kind of a dilemma here there's one hand you have this one option that would seem to solve all your problems in that it would stop it would make everything stop but on the other hand there's a part of you that doesn't want to do that yeah okay how strong do you think that part of you is at the moment not very not very
• 07:30 - 08:00 no no okay saying a percentage wise which which part feels stronger the one that says okay well let's just go home and take all the pills it's much stronger that's much stronger okay do you have you been collecting the pills for that only the ones that I've only the ones the do so those are the anti-depressants in the sleeping tablet okay right
• 08:00 - 08:30 so I'm wondering what you know CU this is quite concerning in a way and I'm quite worried about you in terms of going home and feeling like this and having to deal with the struggle um do you have any ideas of what you think might be helpful for support for you at this point in time
• 08:30 - 09:00 it's hard to even think about anything else rather than think this this point okay do you have cuz I'm wondering how helpful it is for you to to sit at home kind of looking at photographs kind of thinking constantly about your wife and that she's not there and and those kind of things how almost that makes you feel worse so I'm wondering maybe during the time while you're feeling like this
• 09:00 - 09:30 whether we can think of anything that may help you to to kind of feel more supported to feel less alone I could give John a ring I suppose is my brother right going and visit him and his family mhm do you feel that you'd be able to do that
• 09:30 - 10:00 MH I don't want to kind of Burden him with all of this though and just cuz my relationship's in the toilet doesn't mean he has to kind of suffer all of my misery as well okay so you worry about being a burden to him or putting your problems on him okay would would he see it that way
• 10:00 - 10:30 probably not probably not because you've described him as being quite supportive and that's great and and and that you normally have quite a good relationship okay okay so so do you feel that you could contact him say after the session or would you prefer to do it maybe together I can give him a call mhm yeah I going do it after the session when I get home when you get home home
• 10:30 - 11:00 okay um you know as you would was saying a bit earlier sitting at home and looking at photographs and I'm assuming probably your sleep is still quite affected as well from what you were telling me in the last session and and how how are you eating at the moment not much over the last couple of days I haven't really felt you haven't felt like eating at all so so it's it's
• 11:00 - 11:30 really been hard to kind of look at anything else than I just want it to stop and this is my kind of way out of stopping but it kind of goes against kind of a religious beliefs and feeling that this wouldn't be very good for your daughter as well okay so maybe there's a time where you could be with someone with your brother and just to help you through this really kind of tough time until we can start to
• 11:30 - 12:00 work on looking at other things that might be more helpful for you how does that sound to you something I suppose yeah okay would it be helpful for me to maybe give you a call later on to see whether you have kind of contacted your brother and manage to talk to him and I can call him yeah I can do that
• 12:00 - 12:30 if you sound like you feel quite confident that that you'll do that I can do that okay all right as we can see from that scenario Ian was quite depressed and feeling quite helpless and hopeless and was admitting to um having constant suicidal liation or thinking about that he wanted his problems to stop although he wasn't saying that he was actually wanting to die now what would would be important is
• 12:30 - 13:00 to take enough time to actually do a thorough RIS assessment and it was clear that I hadn't been able to get all the information that I would like to in in the brief 10 minutes that you saw some of the things that will be important to to get from Ian would be whether he he would actually make an attempt in that How likely did he feel that he would actually act on his thoughts so asking things like you know how likely do you feel that you would act on the thought that you're
• 13:00 - 13:30 having so if you were to go home now How likely do you feel that you might actually take the anti-depressants and how many do you think you would take the other thing to ask him would be whether he'd actually done a trial run whether he'd taken any extra antidepressant and how that had gone and hopefully this is something that I would have done in an assessment interview with him was to find out whether he'd had any previous attempts of suicide and how what those attempts in
• 13:30 - 14:00 tailed now Ian had said that he would phone his brother however it was unclear as to when he might do that or or how safe he was at that point in time so the other thing I'd want to find out is um the imminence of the risk so How likely he felt he was going to act on these thoughts in addition to then maybe making sure that he actually founded his brother whilst I was in the room with him um because sometimes clients will say yes they'll do this but they may then leave the room and actually not do this so the the really important thing
• 14:00 - 14:30 to think about is how safe is this client to leave your office on their own um he mentioned a couple of protective factors in that he didn't want to hurt himself because of his children or his family and these are always important things to find out um and his support structure in who was around that could help him over the time where he was feeling at is most vulnerable the other thing that you may have noticed when you watched the video was that I tried to engage him in trying
• 14:30 - 15:00 to think of solutions and to get involved with what might help him to feel better and what might help him at that point in time CU often clients who are feeling suicidal or feeling that there's no hope kind of lose their ability to feel that they can make decisions or actually take action within their Liv so trying to engender that is is a really helpful thing to do and engenders hope um the other thing to think about when you're doing risk assessment is that it usually takes longer and you
• 15:00 - 15:30 could see with Y is he was quite depressed and it took him quite a while to open up and to talk about what was going on for him so if you're having another client booked in right after you've got to think about that this is going to upset your timetable you can't just say well it's the the hour is ended and okay off you go because again you've got to ask yourself is this client safe to leave so it it just takes as long as it needs to take for you to get all the information that you need
• 15:30 - 16:00 need thinking about the means is another thing that's important he mentioned that he was taking anti-depressants and having knowledge about how lethal um the means are that a client is thinking about is important so for instance if they're saying they're going to shoot themselves finding out whether they actually have access to a gun or whether they know how a gun works or whe they have access to bullets or things that are important to ask so knowing The lethality um of the means is another important thing to think about and to find
• 16:00 - 16:30 out so there's quite a number of things that you need to find out when you're doing a risk assessment it's the intent how serious are they and how soon do they think they might act on these thoughts that they having the means that they're going to use how they're going to do it and how s how lethal the means are whether they they've had any previous attempts what support structures they've got and whether there any protective factors that might prevent them from actually acting on their thoughts