Danger to Self and Others Flashcards
Low-Risk:
Risk Factors:
- Limited thoughts of harm to self/others
- No plan or intent
- Few risk factors present
Intervention:
- Identify social supports
- Identify coping mechanisms
- Provide referrals for clinical contacts
- Reassess frequently
Moderate-Risk:
Risk Factors:
- Ideation with limited plans and no intent (or vice versa)
- Some risk factors present
Intervention:
- Identify social supports
- Identify coping mechanisms
- Provide referrals for clinical contacts
- Reassess frequently
- Explore alternatives to violence
- Remove lethal means to harm self/others
- Decrease isolation
- Explore the option of medication
High-Risk:
Risk Factors:
- Specific plan with intent
- Access to lethal means
- Many risk factors present
- Limited social support •Impaired self control
Intervention:
- Client should not be left alone.
- If client cannot engage in safety planning for safety, hospitalization should occur.
- Involuntary hospitalization for potential violence can occur if client is mentally ill.
- Duty to warn potential victim and police in case of potential violence
Danger to Self Risk Factors:
- 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.
- Older adults (White men over the age of 85 have the highest risk factor).
- History of mental illness
- Substance abuse
- Prior suicide attempt
- 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
Danger to Other Risk Factors:
- Prior history of violence
- An identified victim/plan
- History of mental illness
- Substance abuse
- Psychotic symptoms (command hallucinations, paranoid delusions)
- Social isolation or limited support system
- Firearms/lethal means available and easy to access
Intervention and Risk Assessment: Step 1
Conduct a biopsychosocial assessment including:
- Environmental supports and stressors
- Medical needs and medications
- Current use of drugs and alcohol
- Coping methods and resources
Intervention and Risk Assessment: Step 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.
- 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).
Intervention and Risk Assessment: Step 3
Establish rapport with the individual.
• Facilitated through a nonjudgmental attitude, respect, reinforcing small gains and resiliency
Intervention and Risk Assessment: Step 4
Identify the major problems and what preceded the crisis.
- 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.
Intervention and Risk Assessment: Step 5
Encourage exploration of feelings and emotions through the use of:
- Active listening
- Paraphrasing
- Reflecting
Intervention and Risk Assessment: Step 6
Explore possible alternatives and positive coping skills.
• What has been helpful in responding to previous crises?
Intervention and Risk Assessment: Step 7
Formulate an action plan.
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):
• 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.
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):
- Hospitalization should occur if a specific suicidal plan and intention is in place and the client is unable to engage in safety planning for his/her own safety
- Client should not be left alone and an ambulance should be called.
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):
- 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.
Intervention and Risk Assessment: Step 8
Follow up with client regarding the resolution of the crisis and to assess:
• 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
