Danger to self/ others Flashcards
● Males are more likely to complete suicide than females
● White people, American Indians, and Alaska Natives have the highest suicide rates
(Hispanics, African Americans, Asians, and Pacific Islanders have the lowest rates)
● Older adults have a higher risk (white men over the age of 85 have the highest risk
factor)
● History of mental illness
● Substance abuse
● Prior suicide attempt(s)
● 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 self risk factors
● Prior history of violence
● An identified victim/plan
● History of mental illness
● Substance abuse
● Psychotic symptoms (command hallucinations, paranoid delusions)
● History of previous involuntary hospitalization
● Social isolation or limited support system
● Firearms/lethal means available and easy to access
Danger to others risk factors
● 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 history of suicide or violence
● Take into consideration risk factors and presence of recent external sources of stress
(e.g., job, school, relationship loss/changes/trauma, victimization history).
● Environmental supports and stressors
● Medical needs and medications
● Current use of drugs and alcohol
● Coping methods and resources
- Assess lethality and imminence of danger to self or others and conduct a biopsychosocial assessment
- Assess lethality and imminence of danger to self or others and conduct a
biopsychosocial assessment - Establish rapport with the individual
- Identify the major problems and what preceded the crisis
- Encourage exploration of feelings and emotions
- Explore possible alternatives and positive coping skills
- Formulate an action plan
- Follow up with client regarding the resolution of the crisis and assess
AEIEEFF?
Intervention and Risk Assessment
● Facilitated through a nonjudgmental attitude, respect, reinforcing small gains and resiliency
- Establish rapport with the individual.
● Inquire about the precipitating event and how that turned into a crisis
● Assess client’s current coping skills—adaptive vs. maladaptive
● Assess the extent of the support system and willingness to use it
● Assess the meaning of the event and what it is symbolic of in this person’s life
- Identify the major problems and what preceded the crisis
● Active listening
● Paraphrasing
● Reflecting
- Encourage exploration of feelings and emotions
● What has been helpful in responding to previous crises?
- Explore possible alternatives and positive coping skills
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 effectively engage in safety planning for his/her own safety
● The 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 has a DSM-5 diagnosis (psychosis, depression, mania,
dementia)
● In a case of potential violence, the clinician has a duty to warn the intended victim and
police.
- Formulate an action plan
● 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
- Follow up with client regarding the resolution of the crisis and assess for…