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When assessing individuals, this author implores
the healthcare provider to show compassion. There has to be eye
contact and a genuineness of caring displayed. Imagine that the
individual you are interviewing and assessing is a member of your
own family. How would you feel if this was your child or parent
you were interviewing? When laypeople and healthcare providers think
of suicide, the majority of the time they picture teenagers. However,
the elderly are more frequently being seen for suicide assessments.
Methodology
When I walk into a room to speak with someone who may be suicidal,
I want to ask open ended questions such as, “Tell me what’s
happening.” I don’t want to ask questions like, “You
do not feel like killing yourself, do you?” This will close
an individual off, and you will not get the responses that are necessary.
If the individual is despondent, then you need to ask more direct
questions. NO KLEENIX, NO TISSUE. This is very important. Many times,
healthcare providers and even family members in the room will grab
tissue to hand the person who is crying, as a gesture of empathy.
I strongly frown on that for the following reason: The flowing of
tears and the physiological affect of flowing tears on one’s
face causes more tears to come, an expression and release of emotion,
which should be encouraged. As soon as the tissue is grabbed, and
the tears are dried, the individual becomes more composed. You do
not want greater composure during a suicide assessment interview.
You want the emotions to be expressed, and you want the tears to
flow freely. Tears are okay, tears are normal, tears are healthy.
Allow the person to cry, allow the person to feel their tears normal
and it is okay for them to cry. Observe your own anxiety around
this issue. Assess yourself. Step outside of yourself while you
are doing the interview. If you’re feeling uncomfortable,
why are you feeling uncomfortable? It is very important for you
to be aware of this while you are doing an assessment. Keep your
feelings in check, but be observant of your feelings.
What are some of the stimuli that occurred in this person’s
life that may have lead this individual to consider suicide? Were
they slow and insidious stressors that had occurred over time? Was
it something sudden? How did it begin, and what have they done recently
to make themselves feel better? Have they tried to self medicate
with alcohol or other substances? Have they tried someone else’s
medication? Have they done certain things to make it worse? For
example, have they listened to certain music, or has visual stimuli
been used to make it worse? Are they on medication? What type of
medication are they taking? How much have they taken? Have they
missed taking their medication? Ask them directly. Healthcare providers
often have a hard time asking the questions, and beat around the
bush. I have seen healthcare providers who may say something like,
“Do you want to…have you had thoughts of…like
wanting to hurt yourself? ASK the person directly, in a matter of
fact manner, which will bring some normalcy to the moment: “Do
you want to kill yourself? Have you thought about killing yourself?
How would you kill yourself if you thought about it? What kind of
plan do you have?” The type of plan is extremely important.
This will tell you the degree of lethality of the plan. If an individual
is living on a farm in central Illinois, and they tell you they
are going to kill themselves by jumping off of a mountain tomorrow,
obviously the lethality is low. If they indicate they want to shoot
themselves, you need to find out if they have any weapons, recreational
guns, shotguns, pistols, if they hunt or shoot sporting clays. These
are important questions to ask in terms of assessing lethality.
Another important question: “Have you ever had these thoughts
before? Have you ever tried it before, and how did you? Another
important question: “What stops you from doing it? What stops
you from going ahead and killing yourself?” That is a very
important question, for this also allows you to tap into the degree
of lethality and urgency. “How would you do it if you had
the chance to kill yourself?” Again, we are assessing the
degree of lethality. Are they religious? Do they have an affiliation
with a religious organization, which does not necessarily mean they
are spiritual. Are they spiritual? Do they believe in God? Do they
pray? Are they atheist? It is important to note that individuals
who do have a belief in God and are spiritual are less likely to
kill themselves. Do they believe in a heaven or hell? There are
individuals who believe in God, but don’t believe in heaven
or hell. Questions to ascertain the belief in a heaven or hell again
are important in assessing the degree of lethality. What is their
peer network like? Do they have close peers and social support?
Where are their family members? Are their family members close by?
Are they 6 hours away? Are they close to their family members? They
may say they have a good social support network, when in reality,
they don’t, and that may be contributing to the their depression
and suicidal thoughts. Do they have children? What ages are their
children? Do they want to live to see their children grow up? What
are their short and long term goals? A very important question in
terms of assessing lethality. What do they see themselves doing
next week? Next month? Next year? If they have some short and long
term goals, it is extremely beneficial and diminishes lethality.
You want to intermingle the above questions during the course of
the assessment phase, and in normal conversation. You don’t
want to ask them as if you were reading off a checklist, coldly
and sterilely.
In brief, the above is how this author performs suicide assessments.
I have found it to be a very beneficial way of engaging with an
individual presenting for a suicide assessment. If I find a high
risk for lethality, then we have a direct admission to save the
individual’s life.
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