5. Suicide/Strength

Question 1

What are unhelpful languages in clinical settings?

Answer 1

We’ve seen nurses asking mental health PT questions like “Do you want to kill yourself?”, which is inappropriate and stereotyping.
It is insightless to reduce the actual suicidal risks.

Question 2

What is the blame on ‘Risk Assessment’?

Answer 2

• clinical settings overemphasised “risk assessment”
• Pt are classified into the stratification of risk as low, medium, and high
• Lack of evidence to prove RA’s effective in suicide prevention
• RA is not effective in reducing aggression or coercive interventions
• RA doesn’t cherish individual wishes, preferences, or perspectives

The UN report indicates that excessive reliance on “biomedical interventions” and “risk assessment” is useless and a waste of time in suicide prevention.
Interventions that are supportive, towards PT needs, and non-coercive is evident to be more prominent in suicide prevention.

Question 3

What are the blames/problems with the current risk assessment formats?

Answer 3

• inclined to biomedical perspective//designed to seek information on Pt’s pathology
• Assessor sees through a narrow bio-medical lens, rather than a holistic view of Pt’s life
• Tick box assessment provides a false sense of security

Question 4

What are the principles of a strength-based approach?

Answer 4

[A shift from “risk assessment” to “needs assessment”]

• focus on ‘past success’, and ‘current strengths’ (coping skills), and ‘future hopes’ (needs, visions for the future)
• SBA adopts a respected, interested, non-blaming, and non-judgemental stance
• SBA assumes that client is competent to figure out their needs and is willing to make positive changes

Question 5

What is the way for strength-based intervention?

Answer 5

• No detailed history is taken//unless for risk assessment
• Thanks client for coming today
• Identify the goal of the client within their frame of reference
  > What do you hope to get out of coming here today?
  > What brings you here today?
  > What are your best wishes for coming here today?
• Language matching to show genuine compassion & building trust
  > using metaphors & analogies
• Seeking strength/pass success
  > What has been helpful in the past in getting you through difficulties in your life?
• Never ask ‘Why?’, which may create anxiety//only ask ‘How’, ‘Where’, ‘When’, ‘Who’ etc.
  > How did you do that? How did you decide to do that?
  > When did it happen? Where did it happen?
• Supportive language to assume change will come
  > Acknowledge: a way of showing empathy, and assures the Pt that distress has been understood
  > Normalise: “de-pathologies” Pt’s experience by assuming it’s not uncommon → bring up confidence
  > Reframing: change will come not from understanding/resolving the problem, but from seeing yourself differently
  > Exception skills: however serious Pt’s problems are, there are always exceptions that contain solutions [What will be different when this problem is solved?]
  > Supportive resources: pets, relationships, social groups

Question 6

Tactics of ‘SCALE’

Answer 6

Scale is used to measure how close Pt is to the desired goal:

• Typical range: “the worst thing has been 0” to “the best thing can be 10”
• It helps to monitor changes in clients’ self-esteem, confidence, motivations …
  > What needs to happen to make you feel more confident?
• It also involves asking Pts to rate their current situation, which help them identify their available resources