Danger to Self

Question 1

Danger to Self Risk Factors

Answer 1

Males more likely to commit suicide than females
Whites, American Indians, and Alaska Natives have highest suicide rates, whereas Hispanics, African Americans, Asians, and Pacific Islanders have the lowest rates.

Question 2

Prior history of violence

An identified victim/plan

Answer 2

Danger to Others Risk Factors

Question 3

Older adults (White men over the age of 85 have the highest risk factor.)
History of mental illness
Substance abuse
Prior suicide attempt

Answer 3

Danger to Self Risk Factors

Question 4

Danger to Others Risk Factors

Answer 4

History of mental illness
Substance abuse
Psychotic symptoms (command hallucinations, paranoid delusions)

Question 5

Family history of mental illness or substance abuse
Family history of suicide
Family violence including physical or sexual abuse
Firearms/lethal means available and easy to access
Hopelessness

Answer 5

Danger to Self Risk Factors

Question 6

Danger to Others Risk Factors

Answer 6

History of previous involuntary hospitalization

Social isolation or limited support system Firearms/lethal means available and easy to access

Question 7

Intervention and Risk Assessment

Answer 7

1. Conduct a biopsychosocial assessment including:
2. Assess lethality and imminence of danger to self or others. If no suicide attempt is in progress (such as having just taken an overdose), potential for harm should be assessed.
3. Establish rapport with the individual.
4. Identify the major problems and what preceded the crisis.
5. Encourage exploration of feelings and emotions
6. Explore possible alternatives and positive coping skills.
7. Formulate an action plan.
8. Follow up with client regarding the resolution of the crisis and to assess

Question 8

Environmental supports and stressors
Medical needs and medications
Current use of drugs and alcohol
Coping methods and resources

Answer 8

1. Conduct a biopsychosocial assessment including:

Question 9

Ask about suicidal or homicidal thoughts and feelings.
Estimate the strength of the individual’s psychological intent to inflict harm. Level of emotional distress (hopelessness, rage)
Recent behaviors (current substance use or intoxication)
Nature of the situation described
Gauge if a plan is made (e.g., Does this person have access to firearms?). Assess for a suicidal or violence history
Take into consideration risk factors and presence of recent external sources of stress (e.g., job, school, relationship loss/changes, victimization history).

Answer 9

2. Assess lethality and imminence of danger to self or others. If no suicide attempt is in progress (such as having just taken an overdose), potential for harm should be assessed.

Question 10

Facilitated through a nonjudgmental attitude, respect, reinforcing small gains and resiliency

Answer 10

3. Establish rapport with the individual.

Question 11

Inquire about the precipitating event and how that turned into a crisis.
Assess client’s current coping skills—adaptive vs. maladaptive.
Assess extent of support system and willingness to use it.
Assess the meaning of the event and what it is symbolic of in this person’s life.

Answer 11

4. Identify the major problems and what preceded the crisis.

Question 12

5. Encourage exploration of feelings and emotions

Answer 12

Active listening
Paraphrasing
Reflecting

Question 13

6. Explore possible alternatives and positive coping skills.

Answer 13

What has been helpful in responding to previous crises?

Question 14

If client is low to moderate risk for harm to self or others (no plan and/or no intent, limited risk factors present, limited intensity and duration of suicidal thoughts, mild dysphoria, positive support system):

Answer 14

Part of Step 7:
Explore alternatives to violence.
Identify and engage supports and/or significant others to decrease isolation, provide support, and remove lethal means to harm self/others.
Implement coping mechanisms.
Establish future linkage (events to look forward to).
Provide clinical referrals for outpatient services and medication if appropriate and a 24-hour crisis number.

Question 15

If client is at high risk for harm to self (specific plans and/or intent, impaired self-control, multiple risk factors present, limited social supports, hopelessness regarding future, severe mental illness/psychosis, access to means, prior attempts):

Answer 15

Hospitalization should occur if a specific suicidal plan and intention is in place and the client is unable to contract for his/her own safety
Client should not be left alone and an ambulance should be called.

Question 16

If client is at high risk for violence towards others (specific plans and/or intent toward identified victim, current substance use, rage, hostility, limited social supports, severe mental illness/psychosis, access to means, prior violence):

Answer 16

An ambulance or police can be called for involuntary hospitalization for potential violence only if a person is mentally ill (psychosis, depression, mania, dementia). In a case of potential violence, clinician has duty to warn the intended victim and police.

Question 17

Physical condition of the client (sleeping, hygiene, eating)
Cognitive understanding of the precipitating event and why the crisis occurred Overall functioning including employment, social, spiritual, and academic (if relevant)
How current stressors are being handled

Answer 17

8. Follow up with client regarding the resolution of the crisis and to assess